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From Screening to Therapy: A Personalized Approach to ROP in a National NICU Setting
Stylianos Christodoulou1, Fedonas Herodotou2, Annalisa Quattrocchi3
1Ophthalmology Department Makarios Hospital, Nicosia 2011, Cyprus.
Insights
Type 1 retinopathy of prematurity (ROP) exclusively affects extremely preterm infants in Cyprus, linked to multiple risk factors. Laser therapy is primary, with anti-VEGF showing promise for treating this serious neonatal condition.
Area of Science:
- Neonatal Ophthalmology
- Perinatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Type 1 ROP requires timely intervention to prevent visual impairment.
- Understanding local incidence and risk factors is crucial for targeted screening and treatment.
Purpose of the Study:
- To determine the incidence of type 1 ROP in Cyprus.
- To identify treatment patterns for type 1 ROP.
- To investigate risk factors associated with type 1 ROP in a tertiary Neonatal Intensive Care Unit (NICU).
Main Methods:
- Retrospective study of infants screened for ROP between January and December 2023.
- Data collection from NICU discharge summaries including gestational age, birth weight, and clinical factors.
- Statistical analysis to compare risk factor distribution among ROP groups.
Main Results:
- 18.0% of infants developed ROP; 6.0% had type 1 ROP requiring treatment.
- Type 1 ROP occurred exclusively in infants born at ≤28 weeks gestational age and <1501 g birth weight.
- Lower gestational age, lower birth weight, systemic infection, surgery, and prolonged oxygen were significant risk factors (p < 0.05).
Conclusions:
- Type 1 ROP in Cyprus is confined to extremely preterm infants and linked to multiple adverse factors.
- Laser photocoagulation remains the standard treatment, with intravitreal bevacizumab used selectively.
- Personalized ROP screening and treatment strategies are essential for optimal neonatal ophthalmic care.
Abstract:
Aim: We aimed to investigate the incidence, treatment patterns, and associated risk factors of type 1 retinopathy of prematurity (ROP) in the only tertiary-level Neonatal Intensive Care Unit (NICU) in Cyprus. Methods: This retrospective study included all infants screened for ROP between January and December 2023. Data were collected from standardized NICU discharge summaries and included gestational age (GA), birth weight (BW), multiple birth, systemic infection, blood transfusion, oxygen therapy, surgical interventions, and ROP outcomes. Infants were categorized into non-ROP, non-type 1 ROP, and type 1 ROP groups. Statistical analysis was performed to identify differences in risk factor distribution. Results: Among 183 infants, 33 (18.0%) developed ROP, with 11 (6.0%) requiring treatment for type 1 ROP. All infants with type 1 ROP were born at ≤28 weeks GA and weighed <1501 g. Type 1 ROP was significantly associated with lower GA, lower BW, systemic infection, surgery, and prolonged oxygen support (p < 0.05). Six infants were treated with laser and three with intravitreal bevacizumab. No recurrence was observed in the anti-VEGF group during 18 months of follow-up. Two infants with aggressive ROP died before treatment. Conclusions: Type 1 ROP in Cyprus occurred exclusively in extremely preterm infants, associated with the cumulative effect of multiple risk factors. Laser remained the primary treatment, while anti-VEGF was used selectively with favorable outcomes. This study emphasizes the importance of tailoring ROP screening and treatment strategies based on individual neonatal risk profiles, supporting a personalized approach to neonatal ophthalmic care.
