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Update on retinopathy of prematurity

Screening, anti-VEGF use, new risk factors may improve detection and treatment

Howard Larkin

Posted: Thursday, November 1, 2018


Manca Tekavčič Pompe MD, PhD

Staying on top of fast-moving developments may help clinicians do a better job identifying and treating retinopathy of prematurity (ROP) patients, Manca Tekavčič Pompe MD, PhD, told the 2018 World Society of Paediatric Ophthalmology and Strabismus Subspecialty Day in Vienna.

Dr Tekavčič Pompe, of University Eye Clinic, Ljubljana, Slovenia, offered a personal perspective on findings included in 350 peer-reviewed ROP papers published in the first eight months of 2018.

Combining weight gain measured during three 10-day intervals following birth with traditional ROP screening criteria of gestational age and birth weight plus hydrocephalus increased sensitivity of screening infants for retinal exams, according to the Growth-ROP (G-ROP) study group. Their retrospective study of nearly 7,500 infants with known ROP outcomes in the USA and Canada identified 100% of ROP type 1 cases while reducing babies screened by 30% (Binenbaum G et al., JAMA Ophthalmol. 2018 Sep 1;136(9):1034-1040). However, while these criteria may be valid in North America and possibly Europe, they may not apply elsewhere, noted Dr Tekavčič Pompe. She cited a study finding that higher gestational age and birth weight than in the G-ROP study were appropriate for ROP screening in Turkey (Bas AY et al., Br J Ophthalmol 2018, epub ahead of print).

Bevacizumab doses much lower than used in adults may preserve retinal structure in ROP patients while reducing risk of systemic anti-VEGF exposure, according to the Pediatric Eye Disease Investigative group. With only four of 112 patients progressing to severe ROP, their dose de-escalation study found bevacizumab doses as low as 0.031mg had good structural outcome, though some eyes needed additional treatments (Wallace DK et al., Ophthalmology. 2018 Jun 7. pii: S0161-6420(18)30491-3 (epub ahead of print)).

“We have to keep in mind systemic and local impact factors,” Dr Tekavčič Pompe said.

Studies of ROP prevalence at a time when more premature babies survive were mixed, with a Taiwan study finding no increase over 10 years in overall ROP percentage, though the numbers requiring treatment grew. However, a Swedish national registry study found increases in ROP incidence, though not type 1 incidence, that appeared related to changes in target oxygen saturation, and significant regional differences in incidence and treatment rates over eight years (Holmström G et al., Acta Ophthalmol 2018 Mar: 96:142-148).

Other recent studies identified the need to pay more attention to pain relief when examining infants, independent ROP risk factors including thrombocytopaenia, anaemia and hyperglycaemia, and growing understanding of genetic influences, Dr Tekavčič Pompe said. “Genetics may be an independent risk factor, especially when we look at different incidence of ROP in different races,” she noted.

Manca Pompe: manca.tekavcic@kclj.si