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National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020)

Joint recommendation of the German Ophthalmological Society (DOG), German Retina Society (RG), Professional Association of Ophthalmologists in Germany (BVA), German Society of Pediatrics and Adolescent Medicine (DGKJ), Professional Association of Pediatricians (BVKJ), Federal Association “The Premature Infant”, Society for Neonatology and Pediatric Intensive Care Medicine (GNPI)

Augenärztliche Screening-Untersuchung bei Frühgeborenen (S2k-Level, AWMF-Leitlinien-Register-Nr. 024/010, März 2020)

Gemeinsame Empfehlung von Deutsche Ophthalmologische Gesellschaft (DOG), Retinologische Gesellschaft (RG), Berufsverband der Augenärzte Deutschlands (BVA), Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berufsverband der Kinder- und Jugendärzte e. V. (BVKJ), Bundesverband „Das frühgeborene Kind“ e. V., Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI)

  • Leitlinien, Stellungnahmen und Empfehlungen
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A Leitlinien, Stellungnahmen und Empfehlungen to this article was published on 10 March 2021

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Abbreviations

Additional findings to be documented:

Neovascularization of the iris (in severe ROP), hyperemia of the iris (increase in visible, dilated vessels in the iris), vitreous haze and floaters, retinal and/or vitreous hemorrhage, moderate pharmacological pupil dilatation.

Aggressive posterior ROP (AP-ROP):

Changes in the region of the posterior pole that, if left untreated, generally progress to stage 5. Characteristic changes: posterior location in zone I or in posterior zone II, marked plus disease (formerly referred to as rush type disease). Disproportionately greater vascular filling and tortuosity in all four quadrants compared to peripheral changes. Shunt vessels between retinal vessels not only in the region of the border of vascularization, where bleeding is possible. Changes do not progress through the normal stages. Flat network of neovascularization at the indistinct boundary between vascularized and non-vascularized retina (easily overlooked). AP-ROP typically extends circumferentially.

Gestational age (GA):

Age at maturity: expressed in full weeks of gestation and days from the 1st day of the last menstrual period (e.g., 28 weeks +5 days = 28 + 5 weeks GA).

Immature retina:

Incomplete retinal vascularization in the absence of ROP. It is essential here to specify the zone into which vascularization extends.

Plus disease:

Vascular dilatation and tortuosity at the posterior pole of the fundus in at least two quadrants.

Postmenstrual age:

Gestational age plus postnatal age (the term “postconceptional” is often used in error).

Postnatal age:

The time elapsed after birth.

Pre-plus disease:

Vascular changes at the posterior pole that do not yet meet the criteria for plus disease.

Threshold disease:

Moderately severe extraretinal proliferations over at least five contiguous or eight non-contiguous clock-hours in zone II in conjunction with plus disease.

Tunica vasculosa lentis anterior (TVL):

A vascular membrane that covers the anterior lens capsule (membrana epipupillaris) during fetal life. When TVL is dilated and has a greater number of tortuous vessels, this is a sign for active ROP.

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Financing the guideline

This guideline has been drawn-up on a purely voluntary basis.

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Authors and Affiliations

  1. Children´s Hospital, University Hospital, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany

    Rolf F. Maier

  2. Department of Neonatology, Children’s Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany

    Helmut Hummler

  3. AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH, Siegburg, Germany

    Ulrich Kellner

  4. Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Tim U. Krohne

  5. Private Practice for Pediatrics and Adolescent Medicine, Arnsberg, Germany

    Burkhard Lawrenz

  6. Justus-Liebig-University Giessen, Giessen, Germany

    Birgit Lorenz

  7. German Federal Association “The Preterm Infant”, Frankfurt, Germany

    Barbara Mitschdörfer

  8. Department of Neonatology, Paediatric Intensive Care, Sleep Medicine, Vest Children’s Hospital Datteln, University of Witten-Herdecke, Datteln, Germany

    Claudia Roll

  9. Department for Ophthalmology, University Medicine Greifswald, Greifswald, Germany

    Andreas Stahl

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  1. Rolf F. Maier
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  7. Barbara Mitschdörfer
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  8. Claudia Roll
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Corresponding author

Correspondence to Rolf F. Maier.

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Conflict of interest

Potential author conflicts of interest are summarized in table form on a separate form (2010 AWMF form). The disclosed potential conflicts of interest were assessed by the lead guideline coordinator, the members of the author group, and the guideline officer of the GNPI. Some authors have relationships to the pharmaceutical companies that produce drugs for the treatment of retinopathy of prematurity. However, since this guideline relates explicitly to the diagnosis and not to the treatment of retinopathy of prematurity, no relevant conflicts of interest in the sense of personal advantages that could have compromised the authors’ impartiality have been expressed. The overview in table form can be viewed on the AWMF homepage: https://www.awmf.org/fileadmin/user_upload/Leitlinien/024_Ges_fuer_Neonatologie_und_Paediatrische_Intensivmedizin/024-010i_S2k_Augenaerztliche_Screening-Untersuchung_Frühgeborene_2020-07.pdf

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. The supplement containing this article is not sponsored by industry.

Additional information

Additional information

This article was first published in the Zeitschrift für Geburtshilfe und Neonatologie (2021), https://doi.org/10.1055/a-1248-0649. Reproduced with the kind permission of Georg Thieme Verlag, Stuttgart, Germany.

Authors are listed in alphabetical order after the lead author.

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Maier, R.F., Hummler, H., Kellner, U. et al. National guideline for ophthalmological screening of premature infants in Germany (S2k level, AWMF guidelines register no. 024/010, March 2020). Ophthalmologie 119 (Suppl 2), 123–136 (2022). https://doi.org/10.1007/s00347-022-01632-4

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