Skip to main content

Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines

Graefe's Archive for Clinical and Experimental Ophthalmology volume 258, pages 1205–1210 (2020)Cite this article

Abstract

Aim

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).

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Kim SJ, Port AD, Swan R et al (2018) Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 63(5):618–637

    PubMed  PubMed Central  Google Scholar 

  2. Stenkuller PG, Du L, Gilbert C et al (1999) Childhood blindness. J AAPOS 3(1):26–32

    Google Scholar 

  3. Shah PK, Prabhu V, Karandikar SS et al (2016) Retinopathy of prematurity: past, present and future. World J Clin Pediatr 5(1):35–46

    PubMed  PubMed Central  Google Scholar 

  4. International Committee for the Classification of Retinopathy of Prematurity (2005) The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 123(7):991–999

    Google Scholar 

  5. Early treatment for retinopathy of prematurity cooperative group (2003) Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 121(12):1684–1694

    Google Scholar 

  6. Gupta MP, Chan RVP, Anzures R et al (2016) Practice patterns in retinopathy of prematurity treatment for disease milder than recommended by guidelines. Am J Ophthalmol 163:1–10

    PubMed  Google Scholar 

  7. Darlow BA, Lui K, Kusuda S et al (2017) International variations and trends in the treatment for retinopathy of prematurity. Br J Ophthalmol 101(10):1399–1404

    PubMed  Google Scholar 

  8. Liu T, Tomlinson LA, Ying GS et al (2019) Treatment of non-type 1 retinopathy of prematurity in the postnatal growth and retinopathy of prematurity (G-ROP) study. J AAPOS 23(6):332.e1–332.e6

    Google Scholar 

  9. Moshfeghi DM (2018) Top five legal pitfalls in retinopathy of prematurity. Curr Opin Ophthalmol 29(3):206–209

    PubMed  Google Scholar 

  10. Bettman JW (1985) The retinopathy of prematurity: medicolegal aspects. Surv Ophthalmol 29(5):371–373

    CAS  PubMed  Google Scholar 

  11. Demorest BH (1996) Retinopathy of prematurity requires diligent follow-up care. Surv Ophthalmol 41(2):175–178

    CAS  PubMed  Google Scholar 

  12. Day S, Menke AM, Abbott RL (2009) Retinopathy of prematurity malpractice claims: the ophthalmic mutual insurance company experience. Arch Ophthalmol 127(6):794–798

    PubMed  Google Scholar 

  13. Mills MD (2009) Retinopathy of prematurity malpractice claims. Arch Ophthalmol 127(6):803–804

    PubMed  Google Scholar 

  14. Reynolds JD (2007) Malpractice and the quality of care in retinopathy of prematurity (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 105:461–480

    PubMed  PubMed Central  Google Scholar 

  15. Wiggins RE Jr, Gold RS, Menke AM (2015) Twenty-five years of professional liability in pediatric ophthalmology and strabismus: the OMIC experience. J AAPOS 19(6):535–540

    PubMed  Google Scholar 

  16. Engelhard SB, Collins M, Shah C et al (2016) Malpractice litigation in pediatric ophthalmology. JAMA Ophthalmol 134(11):1230–1235

    PubMed  Google Scholar 

  17. Vinekar A, Jayadev C, Dogra MR, Shetty B (2016) Improving follow-up of infants during retinopathy of prematurity screening in rural areas. Indian Paediatr 53:S151–S154

    Google Scholar 

  18. Vinekar A, Avadhani K, Dogra M et al (2012) A novel, low-cost method of enrolling infants at risk for retinopathy of prematurity in centers with no screening program: the REDROP study. Ophthalmic Epidemiol 19(5):317–321

    PubMed  Google Scholar 

  19. Adams GG, Bunce C, Xing W et al (2017) Treatment trends for retinopathy of prematurity in the UK: active surveillance study of infants at risk. BMJ Open 7(3):e013366

    PubMed  PubMed Central  Google Scholar 

  20. Sekeroglu MA, Hekimoglu E, Sekeroglu HT, Arslan U (2013) Retinopathy of prematurity: a nationwide survey to evaluate current practices and preferences of ophthalmologists. Eur J Ophthalmol 23(4):546–552

    PubMed  Google Scholar 

  21. Dhawan A, Dogra M, Vinekar A et al (2008) Structural sequelae and refractive outcome after successful laser treatment for threshold retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 45(6):356–361

    PubMed  Google Scholar 

  22. Axer-Siegel R, Maharshak I, Snir M et al (2008) Diode laser treatment of retinopathy of prematurity: anatomical and refractive outcomes. Retina. 28(6):839–846

    PubMed  Google Scholar 

  23. Wu WC, Lien R, Liao PJ et al (2015) Serum levels of vascular endothelial growth factor and related factors after intravitreous bevacizumab injection for retinopathy of prematurity. JAMA Ophthalmol 133(4):391–397

    PubMed  Google Scholar 

  24. Kong L, Bhatt AR, Demny AB et al (2015) Pharmacokinetics of bevacizumab and its effects on serum VEGF and IGF-1 in infants with retinopathy of prematurity. Invest Ophthalmol Vis Sci 56(2):956–961

    CAS  PubMed  Google Scholar 

  25. Sato T, Wada K, Arahori H et al (2012) Serum concentrations of bevacizumab (avastin) and vascular endothelial growth factor in infants with retinopathy of prematurity. Am J Ophthalmol 153(2):327–333

    CAS  PubMed  Google Scholar 

  26. Hong YR, Kim YH, Kim SY et al (2015) Plasma concentrations of vascular endothelial growth factor in retinopathy of prematurity after intravitreal bevacizumab injection. Retina. 35(9):1772–1777

    CAS  PubMed  Google Scholar 

  27. Shukla R, Murthy GVS, Gilbert C et al (2020) Operational guidelines for ROP in India: a summary. Indian J Ophthalmol 68:S108–S114

    PubMed  PubMed Central  Google Scholar 

  28. Multicenter trial of cryotherapy for retinopathy of prematurity (1988) Preliminary results. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Arch Ophthalmol 106(4):471–479

    Google Scholar 

  29. Multicenter trial of cryotherapy for retinopathy of prematurity (1993) 3 1/2- year outcome-structure and function. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Arch Ophthalmol 111(3):339–344

    Google Scholar 

  30. Cryotherapy for Retinopathy of Prematurity Cooperative Group (2001) Multicenter trial of Cryotherapy for Retinopathy of Prematurity: ophthalmological outcomes at 10 years. Arch Ophthalmol 119(8):1110–1118

    Google Scholar 

  31. Backeljauw B, Holland SK, Altaye M, Loepke AW (2015) Cognition and brain structure following early childhood surgery with anesthesia. Pediatrics. 136:e1–e2

    PubMed  PubMed Central  Google Scholar 

  32. Wang X, Xu Z, Miao C-H (2014) Current clinical evidence on the effect of general anesthesia on neurodevelopment in children: an updated systematic review with meta-regression. PLoS One 9:e85760

    PubMed  PubMed Central  Google Scholar 

  33. Quinn GE, Dobson V, Biglan A et al (1995) Correlation of retinopathy of prematurity in fellow eyes in the cryotherapy for retinopathy of prematurity study. Arch Ophthalmol 113(4):469–473

    CAS  PubMed  Google Scholar 

  34. Fielder AR, Shaw DE, Robinson J, Ng YK (1992) Natural history of retinopathy of prematurity: a prospective study. Eye. 6(3):233–242

    PubMed  Google Scholar 

  35. Good WV, Early Treatment for Retinopathy of Prematurity Cooperative Group (2004) Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc 102:233–248 discussion 248-50

    PubMed  PubMed Central  Google Scholar 

  36. Ying GS, Pan W, Quinn GE et al (2017) Inter eye agreement of retinopathy of prematurity from image evaluation in the Telemedicine Approaches to Evaluating of Acute-Phase ROP (e-ROP) study. Ophthalmol Retina 1:347–354

    PubMed  PubMed Central  Google Scholar 

  37. Geloneck MM, Chuang AZ, Clark WL et al (2014) Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial. JAMA Ophthalmol 132(11):1327–1333

    PubMed  Google Scholar 

  38. Roohipoor R, Karkhaneh R, Riazi-Esfahani M et al (2018) Comparison of intravitreal bevacizumab and laser photocoagulation in the treatment of retinopathy of prematurity. Ophthalmol Retina 2(9):942–948

    PubMed  Google Scholar 

  39. Anilkumar SE, Anandi V, Shah PK et al (2019) Refractive, sensory, and biometric outcome among retinopathy of prematurity children with a history of laser therapy: a retrospective review from a tertiary care center in South India. Indian J Ophthalmol 67(6):871–876

    PubMed  PubMed Central  Google Scholar 

  40. Bal S, Ying GS, Tomlinson L, Binenbaum G (2019) Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study Group. Association of weight gain acceleration with risk of retinopathy of prematurity. JAMA Ophthalmol 137(11):1301–1305

    Google Scholar 

Download references

Author information

Affiliations

  1. Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

    Renu P. Rajan, Piyush Kohli, Naresh Babu, C. Dakshayini, Manish Tandon & Kim Ramasamy

Authors
  1. Renu P. Rajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Piyush Kohli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naresh Babu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Dakshayini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manish Tandon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kim Ramasamy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piyush Kohli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Aravind Medical Research Foundation Institutional Ethics Committee, 1, Anna Nagar, Madurai, Tamil Nadu, India (Registration No. ECR/182/INST/TN/ 2013, dated 20 April 2013), institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from parents of all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rajan, R.P., Kohli, P., Babu, N. et al. Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines. Graefes Arch Clin Exp Ophthalmol 258, 1205–1210 (2020). https://doi.org/10.1007/s00417-020-04706-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04706-8

Keywords

  • Advanced postmenstrual age
  • Ectopia
  • International Classification of Retinopathy of Prematurity (ICROP)
  • Retinopathy of prematurity (ROP)
  • Structural changes
  • Type 1 ROP