Outcome-based management of retinopathy of prematurity (original) (raw)

1997, Journal of American Association for Pediatric Ophthalmology and Strabismus

,-a and Charles J. Cooper, MS,-~ for the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity Cooperative Group Purpose:A system is presented for sequentially computing the risk of progression of retinopathy of prematurity (RO P) for infa nts born weighing not more tha n 1250 gm. A personal computer program is used to monitor infa nts' risk of threshold ROP from first appearance of ROP, and the progression in severity is tracked with multiple logistic risk models developed from data in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity. Methods:After entry of the infant's birth weight, gestational age, ethnicity, birth in the current hospital or elsewhere, single or multiple birth, and maturity zone of retinal vessels, risk of progression to threshold severity is calculated. New estimates of risk are computed at onset of ROP and prethreshold ROP (any zone I ROP, zone II stage 2+ or 3) according to the extent of retinal vascularization when ROP first appears, how rapidly ROP progresses, and how severe it is. When threshold ROP (8total or5 contiguous clock hours of stage 3+ in zone I or II)is reached, the system provides separate estimates of riskthatthe eye will have an unfavorable 3-month outcome if treated or not.Results: Estimates of risk of progression to threshold disease among the 4099 patients in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity natural history study varied from less than 1% to more than 70%. For eyes with threshold disease, the risk of an unfavorable outcome at 3 months without treatment varied from less than 10% to more than 90%.Conclusion:This method of tracking identifies infants at high riskfor severe ROP and poor structural outcome. It provides information about prognosis with a specificity heretofore impossible. (J AAPOS 1997;1:46-54) comprehensive approach to medical decision A making generally involves a wide variety of factors. Prominent among these is an evaluation of the likely outcome for the patient with or without therapy. The ophthalmologic management process for retinopathy of prematurity (ROP) requires making decisions during the course of examining premature infants, assessing an eye's prospects for requiring intervention with retinal ablative therapy, and evaluating the likelihood that such intervention will protect the posterior pole from an unfavorable outcome. The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study group has published an analysis of various risk factors that influence the chances for development of progressive ROP that may require treatment, as well as factors that can lead to poor visual or