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   Table of Contents      
LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 2  |  Page : 199-200

Effective screening strategy for retinopathy of prematurity.


Correspondence Address:
V Vedantham


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Source of Support: None, Conflict of Interest: None


PMID: 12831160

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How to cite this article:
Vedantham V. Effective screening strategy for retinopathy of prematurity. Indian J Ophthalmol 2003;51:199-200

How to cite this URL:
Vedantham V. Effective screening strategy for retinopathy of prematurity. Indian J Ophthalmol [serial online] 2003 [cited 2019 Oct 20];51:199-200. Available from: http://www.ijo.in/text.asp?2003/51/2/199/14698

Dear Editor,

I read with great interest the article by Jalali et al, "Programme Planning and Screening Strategy in Retinopathy of Prematurity".[1] The authors have to be congratulated for a well written and informative article that is particularly useful for ophthalmologists involved in the management of retinopathy of prematurity (ROP). There are certain points that I would like to make to supplement and clarify certain issues raised in the article.

1. Along with the five stages (I to V) of ROP, an additional stage 0 could be used to denote the presence of avascular retina[2] prior to the development of ROP along with the documentation of the zone where the vessels have reached, e.g., Stage 0, zone II. This facilitates easier documentation and is important since such eyes also require follow-up.

2. The authors have mentioned that oxygen is not the cause of ROP and have referred to the STOP-ROP trial.[3] In reality, the trial has only proved the safety of supplemental oxygen in cases of prethreshold ROP. Further, the trial researchers recommend that though oxygen restrictions can be eased once ROP occurs, premature infants without ROP should continue to follow oxygen restrictions if their cardiovascular status would allow. Acceptable upper limits of oxygen tension must vary in accordance to the general condition of the infants, but current practice standards target pulse oximetry levels in the range of 80% to 92% for premature infants requiring oxygen[4] with the pa0 2 remaining below 11 kPa.[5] Kenneth W. Wright recently presented the results of a retrospective study comparing the incidence of ROP before and after institution of restriction of supplemental oxygen. (AAPOS meeting, 2003, Hawaii, http://www.osnsupersite.com/view.asp? ID=5021.) He has noted a significant decrease in the incidence and treatment for ROP after the oxygen therapy was reduced.

There is also experimental evidence to indicate that fluctuations in arterial oxygen saturation may increase the incidence of ROP.[6]

3. There is an increasing tendency among retinal surgeons to treat ROP at the prethreshold stage itself (eg. Zone I ROP of any stage with plus disease or stage 3+ ROP with neovascularization less than threshold clock hours). This would enhance the success of any ROP management programme.

4. The article also mentions that further evaluation of ROP is not needed if the retina is fully mature (retinal vessels seen up to the nasal ora serrata). This would be applicable only for eyes with avascular retina (stage 0 disease) to begin with. An additional ophthalmic end point of screening/followup, in eyes with ROP at initial examination would be regression of ROP into Zone III on at least two consecutive weekly examinations.[3]

5. Additional factors that could increase the success of the ROP screening and management programme would be institution of Vitamin E to the premature infants and reduction of ambient light in the neonatal intensive care units.

6. It is also important to remember that ROP is not the only cause of visual impairment in premature infants. Cortical visual impairment resulting from periventricular leukomalacia secondary to hypoxic ischaemic encephalopathy or hydrocephalus secondary to intraventricular haemorrhage could also occur.

 
  References Top

1.
Jalali S, Anand R, Kumar H, Dogra MR, Azad R, Gopal L. Programme planning and screening strategy in retinopathy of prematurity. Indian J Ophthalmol 2003;51:89-99.  Back to cited text no. 1
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2.
Ainsworth JR, Clark D, Watkinson M. Treatment for retinopathy of prematurity : ten years of refinement. Eye News. Vol 6, No.2. Aug-Sep 1999.  Back to cited text no. 2
    
3.
The STOP-ROP Multicenter Study Group. Supplemental therapeutic oxygen for prethrreshold retinopathy of prematurity (STOP-ROP), a randomised, controlled trial. I : primary outcomes. Pediatrics 2000;105:295-310.  Back to cited text no. 3
    
4.
American Academy of Pediatrics, Fetus and Newborn Committee. Clinical considerations in the use of oxygen. In : Freeman RK, Poland RL, Hauth JC, Merenstein GB, editors. Guidelines for perinatal care . Chicago, American Academy of Pediatrics; 1992. pp 197-203.  Back to cited text no. 4
    
5.
Joint Working Party of the Royal College of Ophthalmologists and British Association of Perinatal Medicine. Retinopathy of Prematurity: Guidelines for Screening and Treatment. Royal College of Ophthalmologists, London. 1995.  Back to cited text no. 5
    
6.
Penn JS, Henry MM, Tolman BL. Exposure to alternating hypoxia and hyperoxia causes severe proliferation retinopathy in the new-born rat. Pediatr Res 1994;36:724-31.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  




 

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