Outcomes of Zone 1 Retinopathy of Prematurity
Julius Oatts, MD; Jason Mantagos, MD; Deborah Vanderveen, MD
Harvard Medical School / Boston Children’s Hospital
Boston, MA, USA
Introduction: Retinopathy of prematurity (ROP) in zone 1 is a risk factor for unfavorable visual and structural outcomes. Outcomes are typically only reported for those requiring treatment. We report outcomes for all zone 1 eyes with ROP.
Methods: Since 1996, all infants screened for ROP have been tracked in a STOP-ROP database.1 Structural outcomes and procedures were collected for infants who developed stage 1 ROP in zone 1. Those with follow up to age 2 years were assessed for vision and refractive error.
Results: 196 eyes (110 infants) were in zone 1, 121 eyes (69 infants) had stage 1 ROP. Final retinal status was available for 53 infants (11 followed elsewhere, 5 deceased), who are the subject of this report. Mean gestational age was 24.5±1.3 weeks, birth weight was 682±195 grams. 76 eyes (72%) were type 1 or worse, receiving primary treatment with retinal ablation (79%) or bevacizumab (21%). Unfavorable structural outcomes were noted in 6/16 (62%) eyes treated prior to 2003, compared to 5/60 (8%) treated according to current guidelines.2 Visual acuity correlated with structural status: mean 0.38 (20/47) in eyes not requiring treatment, 0.40 (20/50) in treated eyes with favorable structural outcomes (p = 0.86), and no light perception in all eyes with unfavorable structural outcomes except one with light perception.
Discussion: Presence of zone 1 ROP is a predictor of need for treatment; earlier treatment and favorable structural outcome correlate with better visual outcomes.
Conclusion: Current treatment strategies for zone 1 ROP allow improved structural and visual outcomes.
References: 1. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics. 2000; 105:295-310.
2. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003; 121:1684-94.