Quinn Graham E, Ying Gui-Shuang, Pan Wei, Baumritter Agnieshka, Daniel Ebenezer
Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
JAMA Ophthalmol. 2017 Sep 1;135(9):982-986. doi: 10.1001/jamaophthalmol.2017.2747.
Telemedicine in retinopathy of prematurity (ROP) has the potential for delivering timely care to premature infants at risk for serious ROP.
To describe the characteristics of eyes at risk for ROP to provide insights into what types of ROP are most easily detected early by image grading.
DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of eyes with referral-warranted (RW) ROP (stage 3 ROP, zone I ROP, plus disease) on diagnostic examination from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study was conducted from May 1, 2011, to October 31, 2013, in 1257 premature infants with birth weights less than 1251 g in 13 neonatal units in North America. Data analysis was performed between February 1, 2016, and June 5, 2017.
Serial imaging sessions with concurrent diagnostic examinations for ROP.
Time of detecting RW-ROP on image evaluation compared with clinical examination.
In the e-ROP study, 246 infants (492 eyes) were included in the analysis; 138 (56.1%) were male. A total of 447 eyes had RW-ROP on diagnostic examination. Image grading in 123 infants (mean [SD] gestational age, 24.8 [1.4] weeks) detected RW-ROP earlier than diagnostic examination (early) in 191 (42.7%) eyes by about 15 days and detected RW-ROP in 123 infants (mean [SD] gestational age, 24.6 [1.5] weeks) at the same time (same) in 200 (44.7%) eyes. Most of the early eyes (153 [80.1%]) interpreted as being RW-ROP positive on imaging evaluation agreed with examination findings when the examination subsequently documented RW-ROP. At the sessions in which RW-ROP was first found by examination, stage 3 or more in 123 infants (mean [SD] gestational age, 24.8 [1.4] weeks) ROP was noted earlier on image evaluation in 151 of 191 early eyes (79.1%) and in 172 of 200 of same eyes (86.0%) (P = .08); the presence of zone I ROP was detected in 57 of 191 (29.8%) early eyes vs 64 of 200 (32.0%) same eyes (P = .90); and plus disease was noted in 30 of 191 (15.7%) early eyes and 45 of 200 (22.5%) same eyes (P = .08).
In both early and same eyes, zone I and/or stage 3 ROP determined a significant proportion of RW-ROP; plus disease played a relatively minor role. In most early RW-ROP eyes, the findings were consistent with clinical examination and/or image grading at the next session. Because ROP telemedicine is used more widely, development of standard approaches and protocols is essential.
早产儿视网膜病变（ROP）的远程医疗有潜力为有严重ROP风险的早产儿提供及时护理。
描述有ROP风险的眼睛的特征，以深入了解通过图像分级最容易早期检测出哪些类型的ROP。
设计、设置和参与者：对北美13个新生儿病房中出生体重小于1251克的1257名早产儿进行了远程医疗评估急性早产儿视网膜病变（e-ROP）研究的诊断检查中具有转诊指征（RW）的ROP（3期ROP、I区ROP、附加病变）眼睛的二次分析。数据分析于2016年2月1日至2017年6月5日进行。
进行一系列成像检查并同时进行ROP诊断检查。
图像评估中检测到RW-ROP的时间与临床检查结果进行比较。
在e-ROP研究中，246名婴儿（492只眼睛）纳入分析；138名（56.1%）为男性。诊断检查中共有447只眼睛患有RW-ROP。123名婴儿（平均[标准差]胎龄，24.8[1.4]周）的图像分级在191只（42.7%）眼睛中比诊断检查更早（早期）约15天检测到RW-ROP，在123名婴儿（平均[标准差]胎龄，24.6[1.5]周）的200只（44.7%）眼睛中同时（相同）检测到RW-ROP。大多数早期检测到的眼睛（153只[80.1%]）在成像评估中被判定为RW-ROP阳性，后续检查记录为RW-ROP时与检查结果相符。在首次通过检查发现RW-ROP的检查中，123名婴儿（平均[标准差]胎龄，24.8[1.4]周）的3期或更严重ROP在191只早期眼睛中的151只（79.1%）以及200只相同眼睛中的172只（86.0%）图像评估中更早被发现（P = 0.08）；I区ROP在191只早期眼睛中的57只（29.8%）与200只相同眼睛中的64只（32.0%）被检测到（P = 0.90）；附加病变在191只早期眼睛中的30只（15.7%）和200只相同眼睛中的45只（22.5%）被发现（P = 0.08）。
在早期检测到和同时检测到的眼睛中，I区和/或3期ROP占RW-ROP的很大比例；附加病变起的作用相对较小。在大多数早期RW-ROP眼睛中，检查结果与下一次检查时的临床检查和/或图像分级一致。由于ROP远程医疗应用越来越广泛，制定标准方法和方案至关重要。
