title: The effects of fetal surgery on retinopathy of prematurity development.
abstract: BACKGROUND
  Fetal surgery is selectively offered for severe or life-threatening fetal malformations. These infants are often born prematurely and are thus at risk for retinopathy of prematurity (ROP). It is not known whether fetal surgery confers an increased risk of developing severe ROP relative to published rates in standard premature populations ≤37 weeks of age grouped by birth weight (<1500 grams or ≥1500 grams).
  
  
  METHODS
  This is a retrospective chart review.
  
  
  METHODS
  We reviewed the charts of 137 patients who underwent open fetal/fetoscopic surgery from 1996-2004. Surgical indications included twin-twin transfusion syndrome (TTTS), myelomeningocele (MMC), congenital diaphragmatic hernia (CDH), sacrococcygeal teratoma (SCT), cystic adenomatoid malformation of the lung (CCAM), and twin reversed arterial perfusion sequence (TRAP). Of these, 17 patients had local ROP examination data. Binomial tests were performed to assess whether rates of ROP in our fetal/fetoscopic surgery cohort were significantly different from published rates.
  
  
  RESULTS
  There were 5 patients each with an underlying diagnosis of TTTS and MMC, 2 patients each with CDH and TRAP, and 1 patient each with SCT, CCAM, and mediastinal teratoma. The mean gestational age at surgery was 23(4)/7 ± 2(3)/7 weeks, mean gestational age at birth was 30 ± 2(5)/7 weeks, and mean birth weight was 1449 ± 510 grams (610-2485). Compared to published rates of ROP and threshold ROP, our fetal surgery patients had significantly higher rates of ROP and threshold ROP in both the <1500 grams and the ≥1500 grams group (all p-values < 0.05).
  
  
  CONCLUSIONS
  Fetal/fetoscopic surgery appears to significantly increase the rate of ROP and threshold ROP development. Greater numbers are needed to confirm these observations.
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Sudha
authors.initials: S
authors.lastname: Nallasamy
authors.forename: Stefanie L
authors.initials: SL
authors.lastname: Davidson
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Howell
authors.forename: Holly
authors.initials: H
authors.lastname: Hedrick
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Crombleholme
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.forename: Terri L
authors.initials: TL
authors.lastname: Young
keywords: (ROP); fetal surgery; retinopathy of prematurity