Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Diagnosis and Follow-Up in Retinopathy of Prematurity: Seven-Year Experience of a Single Center Descriptive Research
Prematüre Retinopatisinde Tanı ve Takip: Tek Merkezde 7 Yıllık Deneyim Tanımlayıcı Araştırma
Aslıhan UZUNa, Asena KELEŞ ŞAHİNb
aDepartment of Ophthalmology, Ordu University Faculty of Medicine, Ordu, Türkiye
bDepartment of Ophthalmology, Ordu University Training and Research Hospital, Ordu, Türkiye
Turkiye Klinikleri J Ophthalmol. 2022;31(2):85-91
doi: 10.5336/ophthal.2021-86276
Article Language: EN
Full Text
ABSTRACT
 Objective: To present the incidence and screening results of retinopathy of prematurity (ROP) in preterm infants who were followed-up and treated in Ordu University Training and Research Hospital. Material and Methods: Medical records of 1,995 babies who underwent screening for ROP between January 2014 and June 2021 were reviewed retrospectively. Of these infants, 1,853 patients with a gestational age (GA) of ≤37 weeks who completed all screening sessions were included. Results: Any stage ROP (157 Stage I, 87 Stage II, 19 Stage III, and 43 aggressive ROP) was detected in 306 (16.51%) infants. None of the patients developed Stage IV or V disease. The mean GA (30.30±2.69 weeks) and birth weight (BW) (1,508.20±501.06 g) were significantly lower in patients with ROP at any stage. The rates of ROP were 13.20% and 65.25% in infants with a GA of >28 weeks and ≤28 weeks, respectively. This rates were also 12.05% and 53.23% in patients with a BW of >1,250 g and ≤1,250 g, respectively. Small GA and low BW were significantly associated with the presence of ROP. Severe ROP requiring treatment was detected in 1.2% of infants with a BW of >1,500 g and in 0.5% of patients with a GA of >32 weeks. The disease was spontaneously regressed in 80.39% of patients. Sixty (19.61%) patients received treatment [45 with low dose intravitreal bevacizumab (IVB) injection and 15 with diode laser photocoagulation]. Conclusion: Small GA and low BW are the main risk factors for ROP development. Severe ROP requiring treatment may occur even in heavier babies. Meticulously managed regular screening program providing early diagnosis and treatment prevents Stage IV or V ROP. Additionally, low dose IVB injection seems to be effective in the treatment of aggressive ROP.

Keywords: Retinopathy of prematurity; bevacizumab; light coagulation
ÖZET
 Amaç: Bu çalışmanın amacı, Ordu Üniversitesi Eğitim ve Araştırma Hastanesinde takip ve tedavi edilen preterm infantlarda prematüre retinopatisi (PR) insidansını ve tarama sonuçlarını sunmaktır. Gereç ve Yöntemler: Ocak 2014-Haziran 2021 tarihleri arasında PR taraması yapılan 1.995 bebeğin tıbbi kayıtları retrospektif olarak incelendi. Bu hastalardan tüm tarama seanslarını tamamlayan, gebelik yaşı (GY) ≤37 hafta olan 1.853 hasta çalışmaya alındı. Bulgular: Toplam 306 (%16,51) infantta herhangi bir evre PR (157 Evre I, 87 Evre II, 19 Evre III ve 43 agresif PR) saptandı. Hiçbir hastada Evre IV veya V hastalık gelişmedi. Ortalama GY (30,30±2,69 hafta) ve doğum ağırlığı (DA) (1.508,20±501,06 g) herhangi bir evre PR olan hastalarda anlamlı olarak daha düşüktü. GY>28 hafta ve GY≤28 hafta olan bebeklerde, PR oranları sırasıyla %13,20 ve %65,25 idi. DA>1.250 g ve DA≤1.250 g olan hastalarda ise bu oranlar sırasıyla %12,05 ve %53,23 idi. Düşük GY ve DA, PR varlığı ile anlamlı olarak ilişkili idi. DA>1.500 g olan infantların %1,2'sinde, GY>32 hafta olan bebeklerin ise %0,5'inde tedavi gerektiren ciddi PR saptandı. Hastaların %80,39'unda hastalık kendiliğinden geriledi. Altmış (%19,61) hastaya tedavi [45'ine düşük doz intravitreal bevasizumab (IVB) enjeksiyonu ve 15'ine diyot lazer fotokoagülasyon] uygulandı. Sonuç: Küçük GY ve düşük DA, PR gelişimi için esas risk faktörleridir. Daha ağır bebeklerde dahi tedavi gerektiren şiddetli PR oluşabilir. Erken tanı ve tedaviye olanak sağlayan, titizlikle yürütülen düzenli tarama programı Evre IV veya V PR'yi engeller. Ayrıca agresif PR tedavisinde düşük doz IVB enjeksiyonunun etkili olduğu görülmektedir.

Anahtar Kelimeler: Prematüre retinopatisi; bevasizumab; ışık koagülasyonu
REFERENCES:
  1. Suelves AM, Shulman JP. Current screening and treatments in retinopathy of prematurity in the US. Eye Brain. 2016;8:37-43. [Crossref]  [PubMed]  [PMC] 
  2. Sommer A, Taylor HR, Ravilla TD, West S, Lietman TM, Keenan JD, et al; Council of the American Ophthalmological Society. Challenges of ophthalmic care in the developing world. JAMA Ophthalmol. 2014;132(5):640-4. [Crossref]  [PubMed]  [PMC] 
  3. Chan-Ling T, Gole GA, Quinn GE, Adamson SJ, Darlow BA. Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective. Prog Retin Eye Res. 2018;62:77-119. [Crossref]  [PubMed] 
  4. Bas AY, Koc E, Dilmen U; ROP Neonatal Study Group. Incidence and severity of retinopathy of prematurity in Turkey. Br J Ophthalmol. 2015;99(10):1311-4. [Crossref]  [PubMed] 
  5. Bayraktar BT, Koytak IA, Bayraktar S, Meriç Z. Evaluation of Retinopathy of Prematurity: Four-year Followup Study in a Newly Established Tertiary Neonatal Intensive Care Unit in Turkey. Bezmiâlem Science. 2020;8(2):170-4. [Link] 
  6. Chaudhry TA, Hashmi FK, Salat MS, Khan QA, Ahad A, Taqui AM, et al. Retinopathy of prematurity: an evaluation of existing screening criteria in Pakistan. Br J Ophthalmol. 2014;98(3):298-301. [Crossref]  [PubMed] 
  7. Türk Neonatoloji Derneği/Türk Oftalmoloji Derneği. Türkiye Prematüre Retinopatisi Rehberi 2021 Güncellemesi. Erişim tarihi: 11 Ağustos 2021. Erişim linki: [Link] 
  8. Chiang MF, Quinn GE, Fielder AR, Ostmo SR, Paul Chan RV, Berrocal A, et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021;128(10): e51-e68. [PubMed] 
  9. Good WV; Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004;102:233-48; discussion 248-50. [PubMed]  [PMC] 
  10. Adams GG, Bunce C, Xing W, Butler L, Long V, Reddy A, et al. Treatment trends for retinopathy of prematurity in the UK: active surveillance study of infants at risk. BMJ Open. 2017;7(3):e013366. [Crossref]  [PubMed]  [PMC] 
  11. Darlow BA, Lui K, Kusuda S, Reichman B, Håkansson S, Bassler D, et al; International Network for Evaluating Outcomes of Neonates. International variations and trends in the treatment for retinopathy of prematurity. Br J Ophthalmol. 2017;101(10):1399-1404. [Crossref]  [PubMed] 
  12. Bas AY, Demirel N, Koc E, Ulubas Isik D, Hirfanoglu İM, Tunc T; TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol. 2018;102(12):1711-6. [Crossref]  [PubMed]  [PMC] 
  13. Ekinci A, Akçakaya AA, Yaylalı SA, Sadıgov F. Prematüre retinopatisi: Dört yıllık tarama sonuçlarımız [Retinopathy of prematurity: Our results of four years' screen]. Okmeydanı Tıp Dergisi. 2015;31(3):122-8. [Link] 
  14. Özbek E, Genel F, Atlıhan F, Güngör İ, Malatyalı R, Menteş J, et al. Yenidoğan yoğun bakım ünitemizde prematüre retinopatisi insidansı, risk faktörleri ve izlem sonuçları [Retinopathy of prematurity in our nenatal intensive care unit, incidence, risk factors and outcome]. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi. 2011;1(1):7-12. [Link] 
  15. Özcan PY. 2015 ve 2017 yıllarındaki prematüre retinopatisi insidanslarının karşılaş tırılması [The comparison of the incidences of retinopathy of prematurity in 2015 and 2017]. MN Oftalmoloji. 2018;25(3):169-73. [Link] 
  16. Esen E, Erdem E, Yar K, Demircan N, Soylu M. Prematüre retinopatisi tarama sonuç larımız: İdeal tarama programı nasıl olmalı? [Results of screening for retinopathy of prematurity: how the ideal screening program should be?]. Türk Oftalmoloji Dergisi. 2014;44(1):42-6. [Crossref] 
  17. Hwang JH, Lee EH, Kim EA. Retinopathy of prematurity among very-low-birth-weight infants in Korea: Incidence, treatment, and risk factors. J Korean Med Sci. 2015;30 Suppl 1(Suppl 1):S88-94. [Crossref]  [PubMed]  [PMC] 
  18. Rasoulinejad SA, Montazeri M. Retinopathy of prematurity in neonates and its risk factors: A seven year study in northern Iran. Open Ophthalmol J. 2016;10:17-21. [Crossref]  [PubMed]  [PMC] 
  19. Nassar MM. Screening for retinopathy of prematurity: a report from upper Egypt. Int J Ophthalmol. 2016;9(2):262-5. [PubMed]  [PMC] 
  20. Li ML, Hsu SM, Chang YS, Shih MH, Lin YC, Lin CH, et al. Retinopathy of prematurity in southern Taiwan: a 10-year tertiary medical center study. J Formos Med Assoc. 2013; 112(8):445-53. [Crossref]  [PubMed] 
  21. Gonçalves E, Násser LS, Martelli DR, Alkmim IR, Mourão TV, Caldeira AP, et al. Incidence and risk factors for retinopathy of prematurity in a Brazilian reference service. Sao Paulo Med J. 2014;132(2):85-91. [Crossref]  [PubMed] 
  22. Mintz-Hittner HA, Kennedy KA, Chuang AZ; BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med. 2011;364(7): 603-15. [Crossref]  [PubMed]  [PMC] 
  23. Han J, Kim SE, Lee SC, Lee CS. Low dose versus conventional dose of intravitreal bevacizumab injection for retinopathy of prematurity: a case series with paired-eye comparison. Acta Ophthalmol. 2018;96(4):e475-e478. [Crossref]  [PubMed] 
  24. Wallace DK, Kraker RT, Freedman SF, Crouch ER, Bhatt AR, Hartnett ME, et al; Pediatric Eye Disease Investigator Group (PEDIG). Short-term Outcomes After Very Low-Dose Intravitreous Bevacizumab for Retinopathy of Pre maturity. JAMA Ophthalmol. 2020;138(6): 698-701. [Crossref]  [PubMed]  [PMC] 
  25. Şahin A, Gürsel-Özkurt Z, Şahin M, Türkcü FM, Yıldırım A, Yüksel H. Ultra-low dose of intravitreal bevacizumab in retinopathy of prematurity. Ir J Med Sci. 2018;187(2):417-21. [Crossref]  [PubMed] 

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