Structural Outcome of Treated Retinopathy of Prematurity Patients

Purpose: To evaluate the structural outcomes of treated neonates with retinopathy of prematurity (ROP) Methods: In this cross-sectional study from April 2008 to August 2009, 859 patients were investigated. These neonates had been consulted at the retinal clinic of Farabi Eye Hospital of Tehran University of Medical Sciences. Those with gestational age of no more than 36 weeks and birth weight of below 2,500 g were enrolled to the study. According to the fundoscopic examination of patients, laser treatment alone or with scleral buckle or Avastin, vitrectomy and/or scleral buckle were performed. Treatments were done by two surgeons with one protocol. Indirect laser therapy was performed for threshold and pre-threshold status. In stage 4 when anterior, posterior traction was seen we performed vitrectomy, and when peripheral traction or retrolental fibroplasia was seen scleral buckling was applied. In stage 5 when exudative retinal detachment was observed scleral buckling was performed and in the case of tractional retinal detachment vitrectomy was performed. Results: Study commenced with 734 eyes [405 males (55%) and 329 females (45%)] with ROP. From the total number of 734 eyes, treatment was found necessary for 327 eyes (44%). Among the above mentioned 327 eyes, 231 eyes (70%) were treated by diode laser photocoagulation in which laser treatment was applied in stage 2, stage 3, stage 4A in 90 eyes (38%), 132 eyes (56%), 19 eyes (8.2%), respectively. In 202 eyes (84%) ROP regressed. Univareate analysis showed a significant relation between gestational age (P<0.0000), age of first examination (P<0.001), age of referral (P=0.000), respiratory distress syndrome (RDS) (P=0.02), duration of oxygen therapy (P=0.01), weight (P=0.000) and patients needed treatment. Univareate analysis showed a significant relation between gestational age, age of first examination, age of referral, weight, duration of oxygen and ventilation application, RDS, intraventricular hemorrhage (IVH), sepsis and ROP. In a logistic regression analysis the gestational age, weight, RDS, duration of oxygen therapy were significantly associated with ROP. In a logistic regression analysis regression after laser treatment were significantly associated with risk factors such as gestational age, age at the first referral, birth weight, RDS. In a logistic regression analysis attachment after treatment were significantly associated with gestational age at first examination. Favorable structural outcomes of 84% were occurred in patients treated with laser. Conclusion: Laser photocoagulation resulted in more anatomical success in prethreshold ROP compared with threshold ROP. We had more favorable outcomes in laser treated patients in stage 2 and 3. Vitrectomy resulted in more anatomical success than scleral buckling. Systemic factors had significant effect on the anatomical outcome.