Outcomes of a protocol-based management for zone 1 retinopathy of prematurity: the Indian Twin Cities ROP Screening Program report number 2.
OBJECTIVE
To report the outcomes of zone 1 aggressive posterior retinopathy of prematurity (ROP) treated with aggressive laser photocoagulation by a protocol-based approach over a 10-year period.


METHODS
Prospective, interventional case series.


METHODS



METHODS
Tertiary eye institute and neonatal intensive care units in the twin cities of Hyderabad and Secunderabad in South India.


METHODS
Babies screened under the Indian Twin Cities Retinopathy of Prematurity Screening (ITCROPS) program between January 1, 1997 and March 31, 2007.


METHODS
Multiple sessions of laser photocoagulation at any sign of plus disease with abnormal shunt vessels with or without neovascularization in zone 1.


METHODS
Based on the anatomic status of the retina at the final follow-up, the outcome was classified into good (completely regressed with no vitreoretinal changes), fair (regression with vitreoretinal distortion), or poor (progression into partial or total retinal detachment involving macula). Descriptive statistics (mean and range) were used for gestational age at birth, birth weight, and post-conceptional age at first presentation and at the first intervention. Trends in incidence of zone 1 ROP over 1 decade were analyzed. Outcomes were expressed in terms of proportions and 95% confidence interval (CI).


RESULTS
Of the 3654 babies screened, 227 eyes of 115 babies were detected to have zone 1 aggressive disease, defined as zone 1 retinal vessels having abnormal closed-loop shunts, dilation and tortuosity, flat new vessels, or rapid progression. Laser was performed in 169 eyes. Disease regressed with good outcome in 142 eyes (84%) (95% CI, 77.6-89.2) and progressed to poor outcome in 13 eyes (7.69%) (95% CI, 4.1-12.8), while fair outcome was seen in 6 eyes (3.55%) (95% CI, 1.3-7.5). Thus 148 babies (87.5%) (95% CI, 81.6-92.14) had a favorable outcome. The outcomes in 8 treated eyes (4.7%) lost to follow-up were unknown.


CONCLUSIONS
Zone 1 aggressive ROP has a good outcome if the screening is done early; intervention is prompt and adequate, with frequent follow-up until complete regression is achieved.
Srimati Kannuri Santhamma Centre for Vitreo-retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, India. subhadra@lvpei.org
Subhadra
S
Jalali
Siddharth
S
Kesarwani
Anjli
A
Hussain
D001724:Birth Weight; D002985:Clinical Protocols; D016208:Databases, Factual; D003941:Diagnostic Techniques, Ophthalmological; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007194:India; D007231:Infant, Newborn; D017075:Laser Coagulation; D011446:Prospective Studies; D012163:Retinal Detachment / Q000503:physiopathology / Q000517:prevention & control*; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology