Yang Michael B, Donovan Edward F
Department of Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
J AAPOS. 2009 Dec;13(6):539-45. doi: 10.1016/j.jaapos.2009.10.002.
To determine whether a multivariate risk model can select infants with low-risk eyes for an alternative protocol that reduces retinopathy of prematurity (ROP) screening without loss of effectiveness.
This was a retrospective, nonrandomized, comparative study. We assigned 712 eyes of 357 premature infants of 401-1,250 g birth weights as high or low risk for prethreshold or threshold ROP using a risk model with variables of birth weight, gestational age, multiple birth, race, and gender. Using simulations, infants with high-risk eyes (p > or = 0.15) were screened conventionally, while those with low-risk eyes were screened with the 35q3 protocol (initial examination at 35 weeks postmenstrual age followed by screening every 3 weeks, with increased or decreased intervals based on ROP severity). The resultant reduction in ROP screening and the delay to detection of severe ROP were calculated.
The 35q3 protocol reduced the mean number of eye examinations per infant in the overall population by 13.4% (p = 0.0051). No eyes had a delay to the detection of threshold or type 1 zone 1 ROP. Of a total of 57 type 1 ROP eyes, 2 eyes with type 1 zone 2 ROP were delayed to detection by 1 week. As our study was done prior to the Early Treatment of ROP study, the 2 eyes were observed and regressed without progression to threshold ROP.
A risk-based alternative screening protocol increased the efficiency of ROP screening for infants of 401-1,250 g birth weight without an apparent loss of effectiveness. This investigational approach requires further validation by multicenter studies.
确定多变量风险模型能否筛选出低风险眼睛的婴儿，以便采用替代方案减少早产儿视网膜病变（ROP）筛查，同时不降低有效性。
这是一项回顾性、非随机、对照研究。我们使用包含出生体重、胎龄、多胎、种族和性别的风险模型，将401 - 1250克出生体重的357名早产儿的712只眼睛分为阈值前或阈值ROP的高风险或低风险。通过模拟，高风险眼睛的婴儿（p≥0.15）按常规筛查，而低风险眼睛的婴儿采用35q3方案筛查（月经龄35周时初次检查，随后每3周筛查一次，根据ROP严重程度增加或减少筛查间隔）。计算由此导致的ROP筛查减少情况以及严重ROP检测延迟情况。
35q3方案使总体人群中每名婴儿的平均眼部检查次数减少了13.4%（p = 0.0051）。没有眼睛出现阈值或1型1区ROP检测延迟。在总共57只1型ROP眼睛中，2只1型2区ROP眼睛的检测延迟了1周。由于我们的研究是在ROP早期治疗研究之前进行的，这2只眼睛经观察病情消退，未进展至阈值ROP。
基于风险的替代筛查方案提高了出生体重401 - 1250克婴儿的ROP筛查效率，且有效性未明显降低。这种研究方法需要多中心研究进一步验证。
