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. 2005 Feb;89(2):154-9.
doi: 10.1136/bjo.2004.045815.

Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: a study of motility, refractive, and anatomical outcomes at 6 months and 36 months

J Sahni  1 , N V Subhedar, D Clark
Affiliations

Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: a study of motility, refractive, and anatomical outcomes at 6 months and 36 months

J Sahni et al. Br J Ophthalmol. 2005 Feb.

Abstract

Aim: To compare the visual acuity (VA), spherical equivalent refractive error, motility, and anatomical outcomes in children with treated regressed threshold stage 3 retinopathy of prematurity (ROP) and those with spontaneously regressed subthreshold stage 3 ROP.

Method: 6 month and 3 year data collected from infants examined between 1989 and 1999 with regressed stage 3 ROP, with or without treatment were retrospectively reviewed.

Results: 85 infants were included in this study. 40 eyes received cryotherapy, 81 eyes laser photocoagulation, and 34 eyes had spontaneously regressed subthreshold stage 3 ROP. Grating acuity score > or =2 cycles/degree (c/d) at 6 months was predictive of optotype acuity > or =6/9 in 69% of eyes and a score <2 c/d at 6 months was predictive of acuity < 6/9 in 88% of eyes. Eyes with subthreshold stage 3 ROP were twice as likely to have VA of 6/9 or better at 36 months than the treated eyes. The mean spherical equivalent refractive error at 36 months was -6.5 dioptres (D) (-21.5D to +1.38D) in cryotherapy treated eyes, -2.4D (-13D to +4D) in the laser group, and -0.22D (-9D to +2.25D) in the subthreshold group. Eyes within the treated groups were more myopic than the eyes within the spontaneously regressed group (p = 0.005). At 36 months, 42 out of the 85 infants (that is, 49%) had strabismus (44% in the cryotherapy group, 26% in the laser group, and 25% in the subthreshold group). There was a statistically significant association between the presence of strabismus and anisometropia (p = 0.016) and strabismus and intraventricular haemorrhage (IVH) (p = 0.005). There was a statistically significant difference in the incidence of strabismus between mild and moderate and severe grade IVH (p = 0.01). Eight out of 40 eyes in the cryotherapy group and six out of the 81 eyes in the laser group developed macular ectopia. None of the eyes in the spontaneously regressed group had macular dragging.

Conclusions: In this study, the grating acuity at 6 months was a good predictor of the 3 year optotype acuity in all groups. Eyes with spontaneously regressed subthreshold stage 3 ROP were associated with better vision at 3 years of age and a lesser degree of myopia compared to the treated groups. Strabismus developed predominantly in the treated groups and was frequently associated with neurological damage and/or anisometropia. The spontaneously regressed subthreshold stage 3 group had a better anatomical outcome compared to the groups in which the retinopathy regressed following treatment.

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Figures

Figure 1
Figure 1
Distribution of visual acuity for eyes with treated threshold stage 3 ROP (laser 81 eyes; cryotherapy 40 eyes), and eyes with subthreshold stage 3 ROP (34 eyes). (A) At 6 months grating acuity scores ⩾2 cycles/degree were taken to be favourable. (B) At 36 months optotype acuity of ⩾6/9 were categorised as favourable.
Figure 2
Figure 2
(A) Median refractive error and ranges at 6 months. (B) Median refractive error and ranges at 36 months.
See this image and copyright information in PMC

Comment in

  • Retinopathy of prematurity's turning point.
    Good WV, Gendron RL. Good WV, et al. Br J Ophthalmol. 2005 Feb;89(2):127-8. doi: 10.1136/bjo.2004.058560. Br J Ophthalmol. 2005. PMID: 15665336 Free PMC article. No abstract available.

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