Treatment outside the Recommended Guidelines for Retinopathy of Prematurity (ROP): Prevalence, Characteristics, and Issues

• Published in: Journal of clinical medicine Vol. 11; no. 1; p. 39
• Main Authors: Lemaître, Daniel, Barjol, Amandine, Abdelmassih, Youssef, Farnoux, Caroline, Martin, Gilles C, Metge, Florence, Chapron, Thibaut, Caputo, Georges
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.01.2022; MDPI
• Subjects: Ablation; bevacizumab IVI; Birth weight; Classification; Clinical medicine; ETROP; General anesthesia; Gestational age; guidelines; Human health and pathology; laser photoablation; Lasers; Life Sciences; Monoclonal antibodies; Newborn babies; Pediatrics; Retinal detachment; retinopathy of prematurity; Sensory Organs; Statistical analysis; United States > US; guidelines; laser photoablation; retinopathy of prematurity; ETROP; bevacizumab IVI; A; C; D; F; Martin; Farnoux; G. Treatment outside the retinopathy of prematurity; Abdelmassih; T; Lemaître; Metge; Barjol; Chapron; Y; G.C; Caputo
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11010039

This study aims to assess the prevalence and characteristics of preterm infants with retinopathy of prematurity (ROP) treated outside the recommended guidelines. In this retrospective monocentric cohort, we included all premature children treated in our department for ROP by laser photoablation or anti-VEGF intravitreal injection. The main outcome was treatment of both eyes for ROP less severe than pre-threshold type 1, treated outside ETROP guidelines. A total of 114 children received treatment for ROP in our department, among whom 32 (28.1%) children received treatment for indications outside the ETROP guidelines for both eyes. The indications outside the guidelines were persistent stage 2 or 3 ROP that showed no evidence of regression after 41 weeks of corrected gestational age (11 children; 34.4%), pre-plus stage (11; 34.4%), difficulties in disease staging (7; 21.9%), type 2 ROP with plus disease (2; 6.2%), and treatment due to logistical difficulties (1; 3.1%; hospitalized in neonatal units hundreds of miles away from our department, with no fundus examination possible in the neonatal unit). To resume, in our cohort, 28.1% of children received treatment for ROP less severe than pre-threshold type 1 both eyes. The main indications for off-label treatment were the persistence of active ROP during follow-up and the presence of pre-plus-stage disease. Our data suggest the need to update ROP treatment criteria to reflect real-life practices. Additional studies are required in order to evaluate the long-term benefits and side effects of treatments outside the recommended indications, and to establish revised treatment guidelines.