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Threshold retinopathy of prematurity in neonates less than 25 weeks' estimated gestational age
D K Coats1, E A Paysse, P G Steinkuller
1Department of Ophthalmology and the Department of Pediatrics, Cullen Eye Institute, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA. dcoats@bcm.tmc.edu
Insights
Extremely premature infants born before 25 weeks' gestational age have a high incidence of retinopathy of prematurity (ROP), with many developing threshold ROP. This condition may appear earlier in these very preterm infants.
Area of Science:
- Neonatology
- Ophthalmology
Background:
- Survival rates for extremely premature infants have improved.
- Recent data on retinopathy of prematurity (ROP) characteristics and threshold ROP incidence in the most premature infants are lacking.
- This study addresses the risk of ROP and threshold ROP in infants born before 25 weeks' estimated gestational age (EGA).
Purpose of the Study:
- To determine the risk of developing ROP and threshold ROP.
- To investigate ROP characteristics in infants <25 weeks' EGA.
Main Methods:
- Retrospective review of infants born before 25 weeks' gestation (1994-1997).
- Included 49 infants (97 eyes); 42 born at 24 weeks, 7 at 23 weeks.
- Mean follow-up was 6.3 months; ophthalmology screening initiated at 5 weeks.
Main Results:
- All 97 eyes developed ROP.
- 41% of infants (40% of eyes) developed threshold ROP at a mean post-conceptional age of 34 weeks.
- 14% of patients (13% of eyes) had prethreshold disease that regressed without treatment.
Conclusions:
- Incidence of threshold ROP is increased in infants ≤25 weeks' EGA compared to those with greater EGA.
- Threshold ROP may manifest earlier in this subgroup of neonates.
Introduction:
The survival rate of extremely premature infants has increased. No recent study has investigated the characteristics of retinopathy of prematurity (ROP) or the incidence of threshold ROP in the most severely premature infants. We undertook this study to determine the risk of developing ROP and threshold ROP in the growing sub-population of infants <25 weeks' estimated gestational age (EGA).
Methods:
A retrospective review of infants born before the 25th week of gestation between the years 1994 and 1997 was performed. Of 49 infants examined (97 eyes), 42 were born in the 24th week of gestation and 7 were born in the 23rd week. Mean follow-up was 6.3 months (range, 2.5-37 months). Ophthalmology screening examinations were initiated at 5 weeks of age and continued until the infants were no longer at risk for serious ROP.
Results:
ROP developed in all (97) eyes. Thirty-nine of 97 (40%) eyes in 20 of 49 (41%) infants developed threshold ROP, diagnosed at a mean post-conceptional age of 34 weeks. Thirteen (13%) eyes of 7 (14%) patients developed prethreshold disease and regressed without treatment.
Conclusion:
There is an increased incidence of threshold disease in infants