Treatment of Pre-Type 1 Disease in the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study
Tianyu Liu, BA; Lauren A. Tomlinson, BS; Gui-shuang Ying, PhD; Michael B. Yang, MD; Gil Binenbaum, MD, MSCE;
G-ROP Study Group
The Children’s Hospital of Philadelphia
Introduction: Current ROP guidelines recommend treatment for ETROP Type 1 pre-threshold disease. We sought to determine the prevalence and characteristics of eyes treated for ROP not meeting Type 1 criteria.
Methods: Retrospective study of infants from 29 North American hospitals between 2006-2012 (G-ROP Study). Primary outcomes were prevalence and characteristics of eyes treated for ROP milder than Type 1 ROP.
Results: 1,004 eyes of 7,483 infants in the G-ROP study received ROP treatment. 151 eyes (1% of all eyes, 15% of treated eyes) of 102 infants without Type 1 ROP underwent treatment at a mean post-menstrual age (PMA) 38 weeks (range 32-49). 126 (83.4%) eyes were treated for Type 2 ROP and 25 (16.6%) eyes were treated for milder ROP. Among the 102 infants, 50 (49%) had Type 1 ROP in the worse eye; 38 (37%) had Stage 3 Zone 2 pre-plus in the worst eye; and 12 (12%) had stage 3 without plus (10 were treated for stage 3 before 40 weeks PMA; 2 were treated for persistent stage 3 at 47 and 49 weeks PMA).
Discussion: Ophthalmologists commonly treat both eyes even if only one eye has Type 1 ROP. Some clinicians consider pre-plus disease in treatment decisions. Treatment for persistent stage 3 is less common.
Conclusion: One-sixth of eyes treated for ROP have disease milder than currently recommended Type 1 criteria. Clinician judgment of risk for progression supersedes recommended treatment criteria in such cases and is usually related to contralateral Type 1 disease or pre-plus vascular changes in one or both eyes.