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[Managing of retinopathy of prematurity in a tertiary center]
E Bui Quoc1, O Roche, S Hakiki
1Service d'Ophtalmologie, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris 15. emmanuel.buiquoc@worldonline.fr
Insights
Retinopathy of prematurity (ROP) is a severe complication in premature infants. Despite known risk factors and treatments, ROP remains difficult to manage, often leading to legal blindness.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Context:
- Retinopathy of prematurity (ROP) is a significant cause of blindness in premature infants.
- Risk factors for ROP are well-established, yet its management remains challenging.
- Advances in neonatal care have led to increased survival of very premature infants, potentially increasing ROP incidence.
Purpose:
- To describe the clinical features, treatments, and outcomes of retinopathy of prematurity cases.
- To evaluate the effectiveness of different treatment modalities for ROP.
- To highlight the challenges in managing severe ROP and its impact on visual prognosis.
Summary:
- A retrospective review of 54 children (108 eyes) with ROP managed between 1996-2002.
- Most cases presented with severe ROP (stage 3 or higher).
- Treatments included laser photocoagulation (77% effective), cryotherapy (71.5% effective), and surgery (25% effective for scleral buckling); vitrectomy had a high failure rate. Legal blindness occurred in 33 eyes.
Impact:
- The study underscores the difficulty in managing severe ROP, even with established treatment protocols.
- Despite advances, ROP continues to be a considerable cause of morbidity in premature infants.
- Highlights the ongoing need for early detection, accurate diagnosis, and timely therapeutic interventions for ROP.
Introduction:
Retinopathy of prematurity is a complication of prematurity whose risk factors are well known. Its prognosis remains fearsome and its treatment is difficult.
Patients And Methods:
Fifty-four children were managed (108 eyes analyzed) for retinopathy of prematurity in the Ophthalmology Ward of Necker-Enfants-Malades Hospital between 1996 and 2002. A retrospective review of those cases was performed to describe their clinical features, their treatment and their outcome.
Results:
Mean gestational age was 26.75 weeks after the mother's last period (24-32.5 weeks) and mean birth weight was 842 g (530-2260 g). Stage zero occurred in ten eyes, stage 1 in two eyes, stage 2 in seven eyes, stage 3 in 42 eyes, stage 4 in ten eyes, stage 5 in 24 eyes, and after-effects stage in 13 eyes. Initial treatment (combined treatments possible) was abstention in 45 eyes, cryotherapy in 16 eyes, laser photocoagulation in 43 eyes, surgical treatment of 13 eyes (scleral buckling or vitrectomy). Cryotherapy was effective in 71.5% of cases, photocoagulation was effective in 77%, and scleral buckling was effective in 25%. Vitrectomy failed in the five eyes treated. Outcome was complicated by legal blindness in 33 eyes.
Discussion And Conclusion:
The cases of retinopathy of prematurity that we manage are often severe, stage 3 or above, which explains the outcome of the patients. The 7-year experience reported herein shows how difficult it is to manage this condition, though the need for its detection, diagnosis criteria, and therapeutical indications are well known. Because younger and smaller premature newborns are successfully managed by pediatricians, retinopathy of prematurity is far from having vanished and its morbidity is considerable.
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