Treating Retinopathy of Prematurity with Dexamethasone Eye Drops: A Difference-in-Differences Study in Sweden Using
Lotta Akc Gränse1, Hanna Maria V Öhnell1, Gerd Holmström2
1Retinopathy of Prematurity Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Ophthalmology, Skåne University Hospital, Malmö and Lund, Sweden.
Insights
Dexamethasone eye drops significantly reduced the need for traditional treatments in infants with severe retinopathy of prematurity (ROP). This intervention offers a cost-effective method to decrease visual impairment caused by ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of severe visual impairment in preterm infants.
- Traditional treatments for ROP, such as laser ablation and anti-VEGF injections, can be invasive.
- Identifying effective, less invasive interventions for ROP is crucial.
Purpose of the Study:
- To evaluate the impact of dexamethasone eye drops on the progression of type 2 retinopathy of prematurity (ROP).
- To determine if dexamethasone eye drops reduce the requirement for traditional ROP treatments.
Main Methods:
- A register-based cohort study comparing ROP treatment frequencies before and after dexamethasone introduction.
- Inclusion of preterm infants born before 30 weeks' gestation across four Swedish sites.
- Utilized difference-in-differences analysis to compare treatment rates between intervention and control sites.
Main Results:
- At the intervention site, traditional ROP treatment incidence decreased significantly in infants with severe ROP (72% to 13%) and all screened infants (5.6% to 1.8%).
- Control sites showed no significant changes in treatment rates.
- Adjusted analyses indicated a markedly larger decline in traditional ROP treatments at the intervention site (interaction OR, 0.05; P < 0.001).
Conclusions:
- Introduction of dexamethasone eye drops was associated with a significant reduction in traditional ROP treatments for infants with severe ROP.
- Low-dose dexamethasone eye drops may offer a simple, cost-effective, and noninvasive approach to manage ROP.
- Further research is recommended to validate these findings.
Purpose:
To estimate the effect of dexamethasone eye drops on the risk of progression from type 2 retinopathy of prematurity (ROP) to ROP requiring traditional treatments.
Design:
Register-based cohort study.
Participants:
Preterm infants born before 30 weeks' gestation from 2015-2018 (control years) and from 2020-2021 (intervention years) registered in the Swedish Quality Register for ROP at 4 Swedish sites were included. In 1 of these sites, the intervention site, topical dexamethasone was introduced during the later period when type 2 ROP was diagnosed.
Methods:
The frequency of traditional ROP treatments (laser ablation or intravitreal injection of anti-VEGF) was compared between the 2 periods at sites that had and had not introduced topical dexamethasone during the later period. Analyses were conducted both on infants with severe ROP and on all included infants. The difference-in-differences statistical method was used.
Main Outcome Measures:
The proportion of infants that required traditional ROP treatment in each group and the interaction odds ratio, adjusted for potential confounding factors.
Results:
At the intervention site, the incidence of traditional ROP treatment fell from 23/32 (72%) to 4/32 infants (13%; P < 0.001) with severe ROP and from 23/409 (5.6%) to 4/217 screened infants (1.8%; P = 0.03). For the 3 control sites, the equivalent numbers were from 82/175 (47%) to 32/57 infants (56%; P = 0.22) and from 82/950 (8.6%) to 32/441 infants (7.3%; P = 0.38). The difference-in-differences analyses resulted in an adjusted interaction odds ratio of 0.05 (95% confidence interval, 0.01-0.22; P < 0.001) for infants with severe ROP, suggesting a markedly larger decline in occurrence of traditional ROP treatments at the intervention site.
Conclusions:
In this population of infants with severe ROP, the introduction of dexamethasone eye drops was associated with a significant reduction in the proportion of infants requiring traditional ROP treatments. A timely administration of low-dose dexamethasone eye drops may serve as a simple, cost-effective, and noninvasive intervention to reduce one of the leading causes of severe visual impairment worldwide. Further studies are needed to confirm our findings.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
