Outcome of retinopathy of prematurity patients following adoption of revised indications for treatment

Abstract

Background: The Early Treatment for Retinopathy of Prematurity study (ETROP), published in 2003, established new guidelines for treatment of retinopathy of prematurity (ROP) and demonstrated improved outcomes compared to previous guidelines. We examined outcomes before and after implementing the ETROP recommendations.

Methods: A retrospective chart review was performed using records of infants who had laser ablations for ROP performed from January, 2000 through December, 2005. Data collected included date of birth; birth weight; estimated gestational age (EGA); grading of ROP; date of laser ablation; and outcome of laser surgery. Univariate association with threshold or prethreshold treatment (Pre-ETROP and Post-ETROP, respectively) were assessed using t-tests or Wilcoxon tests. Additional comparison between groups was performed using Fisher's exact tests.

Results: 581 patients were examined before and 464 after December 2003. Of these, 29/581 (5% - Pre-ETROP Group) and 53/464 (11% - Post-ETROP Group) patients advanced to criteria requiring laser treatment respectively (P = 0.0001). The average estimated gestational age (EGA) at birth was 26.3 and 25.2 weeks, with an average birth weight of 888 and 707 grams for Pre and Post-ETROP Groups, respectively. Stage 5 retinal detachment (RD) developed in 10.3% of eyes in the Pre-ETROP Group and 1.9% of eyes in the Post-ETROP Group (P = 0.02).

Conclusion: After the ETROP guidelines were implemented, there was a decrease from 10.3% to 1.9% of eyes developing Stage 5 retinal detachment, despite this group having a lower average EGA and lower average birth weight. These results underscore the importance of adoption of the Revised Indications.

Figure 1

Comparison of Stage 5 RD development between treatment groups. Percentage of patients (left) and eyes (right) developing Stage 5 RD. There was a significantly lower incidence of Stage 5 RD in eyes of Post-ETROP vs. Pre-ETROP patients (right, P = 0.02). The incidence of Stage 5 RD was lower in Post-ETROP vs. Pre-ETROP patients (left), though this difference did not reach statistical significance (P = 0.34).