Rajan Renu P, Kohli Piyush, Babu Naresh, Dakshayini C, Tandon Manish, Ramasamy Kim
Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
Graefes Arch Clin Exp Ophthalmol. 2020 Jun;258(6):1205-1210. doi: 10.1007/s00417-020-04706-8. Epub 2020 Apr 22.
To evaluate the incidence and clinical indications for which eyes were treated for retinopathy of prematurity (ROP) outside the guidelines set by International Classification of ROP (ICROP).
Medical records of the patients treated at a single tertiary care ophthalmology hospital for ROP from January 2016 to December 2019 were retrospectively analysed to evaluate the indications for which they were treated.
Out of 241 eyes, 33 eyes (13.7%) were treated outside the guidelines. The reasons for the treatment outside the guidelines were structural changes (n = 24, 72.7%), persistent stage 3 ROP that did not show any sign of regression for 6 weeks (n = 7, 21.2%) and active ROP with fellow eye being treated (n = 2, 6.1%). The recorded specific structural changes were tangential traction with temporal vessel straightening concerning for macular distortion and ectopia (n = 5, 15.2%), and stage 3 neovascularisation or ridge with anteroposterior traction with risk of progression to stage 4 disease (n = 19, 57.6%). Pre-plus disease was present in 11 eyes (33.3%).After the treatment, ROP stages regressed and retinal vessels grew either until the ora or at least into zone III in all the treated eyes. None of the eyes showed worsening of structural changes after treatment. The mean follow-up of the patients was 12.4 ± 11.7 months.
Experts occasionally recommend treatment in eyes with disease milder than type 1 ROP. This study may help paediatric retinal practitioners in decision-making in borderline cases.
评估在国际早产儿视网膜病变分类（ICROP）指南之外接受早产儿视网膜病变（ROP）治疗的眼睛的发生率及临床指征。
回顾性分析2016年1月至2019年12月在一家三级眼科专科医院接受ROP治疗的患者的病历，以评估其治疗指征。
在241只眼中，33只眼（13.7%）在指南之外接受了治疗。超出指南进行治疗的原因包括结构改变（n = 24，72.7%）、持续6周未显示任何消退迹象的3期ROP（n = 7，21.2%）以及对侧眼接受治疗时的活动性ROP（n = 2，6.1%）。记录的具体结构改变包括与黄斑变形和异位相关的颞侧血管变直的切线牵引（n = 5，15.2%），以及有进展为4期疾病风险的3期新生血管或嵴伴前后牵引（n = 19，57.6%）。11只眼（33.3%）存在Plus病变。治疗后，所有接受治疗的眼睛ROP分期均消退，视网膜血管生长至锯齿缘或至少进入Ⅲ区。治疗后无眼显示结构改变恶化。患者的平均随访时间为12.4±11.7个月。
专家偶尔会建议对病情轻于1型ROP的眼睛进行治疗。本研究可能有助于儿科视网膜医生在临界病例中做出决策。
