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Published on: September 11, 2013
Retinal detachment associated with subthreshold retinopathy of prematurity
S J Gurdian1, P L Gehlbach, A P Hunyor
1Casey Eye Institute, Portland, 97201-4197, USA.
Insights
Retinopathy of prematurity (ROP) can rarely lead to retinal detachment without clear signs of threshold disease. Very low birth weight infants may have unpredictable ROP progression, necessitating further study.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Standard ROP screening protocols aim to identify infants requiring treatment based on 'threshold disease'.
Purpose of the Study:
- To describe a cohort of infants with retinopathy of prematurity (ROP) who developed retinal detachment without meeting established criteria for threshold disease.
- To analyze factors contributing to ROP progression in this unique patient group.
Main Methods:
- Retrospective analysis of seven infants with ROP who progressed to retinal detachment between 1993 and 1998.
- Comparison of these infants to the larger Cryotherapy for Retinopathy of Prematurity Study (CRYO-ROP) cohort.
- Evaluation of ROP staging, including clock hours, stage, and presence of plus disease.
Main Results:
- Six of seven infants were male, with a mean birth weight of 877g and gestational age of 26 weeks.
- Retinal detachment occurred at a mean postconceptual age of 41 weeks.
- Failure to reach threshold was primarily due to lack of plus disease (8/10 eyes), rather than insufficient clock hours or stage (2/10 eyes).
Conclusions:
- Retinal detachment can occur in ROP without antecedent threshold disease, even when following established examination protocols.
- Very low birth weight is associated with a less predictable ROP course.
- Lack of plus disease is a more common reason for failing to reach threshold than insufficient disease extent; further research on treating subthreshold ROP is warranted.
Purpose:
To report a series of infants who progressed from mild retinopathy of prematurity (ROP) to severe ROP with retinal detachment without demonstrating detectable threshold disease.
Methods:
Between January 1993 and August 1998, seven infants at Oregon Health Sciences University, followed in accordance with the Cryotherapy for Retinopathy of Prematurity Study (CRYO-ROP) protocol, progressed to retinal detachment despite documentation that threshold had not been reached. This outlying subset of patients was analyzed and compared to the cohort in the CRYO-ROP study.
Results:
Six of 7 patients were male, 6 (86%) patients had symmetric disease, and all patients were born outside the study hospital. Mean birth-weight was 877 g and mean gestational age was 26 weeks. Mean postconceptual age at the time of retinal detachment was 41 weeks. Because of bilateral detachment in 3 patients, the total number of study eyes is 10. Failure to achieve threshold resulted from insufficient clock hours or insufficient stage in 2 eyes and lack of plus in 8 eyes. Zone I disease was present in 1 eye.
Conclusion:
Rarely, despite adhering to ROP examination protocol, the retina may detach without demonstrating antecedent threshold disease. Very low birthweight is a factor that may lead to a less predictable course. This study found a lack of plus disease results in failure to reach threshold more often than the occurrence of insufficient clock hours of stage 3 disease. Further study is needed to determine if selected cases of subthreshold ROP may benefit from ablative therapy.
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