Evidence-based screening criteria for Retinopathy of Prematurity - Natural history data from the CRYO-ROP and LIGHT-ROP studies
Evidence-based screening criteria for Retinopathy of Prematurity - Natural history data from the CRYO-ROP and LIGHT-ROP studies
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DOI：
10.1001/archopht.120.11.1470
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发表时间：
2002-11-01
影响因子：
--
通讯作者：
Tung, B
中科院分区：
文献类型：
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作者：
Reynolds, JD;Dobson, V;Tung, B
背景：冷冻疗法治疗早产儿视网膜病变 (CRYO-ROP) 的多中心试验证明了治疗阈值 ROP 的有效性，并表明需要在全球范围内进行 ROP 筛查。以前的 ROP 筛查指南主要基于临床印象；我们现在可以制定基于证据的筛查建议。目的：确定适当的年龄和视网膜检眼镜征象，以确定何时开始和结束急性期 ROP 筛查。设计：分析 2 项前瞻性随机对照试验的数据：CRYO-ROP（1986 年 1 月 1 日至 1987 年 11 月 30 日）和 ROP 减光（LIGHT-ROP）（1995 年 7 月 1 日至 3 月 31 日） 1997 年）。地点：美国 23 个 CRYO-ROP 研究中心和 3 个 LIGHT-ROP 研究中心的新生儿重症监护病房。患者：对 4099 名出生体重小于 1251 克的婴儿（CRYO-ROP 研究）和 361 名出生体重小于 1251 克且胎龄小于 31 周的婴儿（LIGHT-ROP 研究）进行了眼睛连续检查研究）。结果：99% 的婴儿患有视网膜疾病 表明在月经后 31 周或实足年龄 4 周之前未观察到不良结果的风险。表明 ROP 导致视力丧失的风险很小或已经过去的迹象是，婴儿在月经后 45 周时没有出现阈值前 ROP 或更严重的情况，视网膜血管化进展到 III 区而之前没有 II 区 ROP，并且完全血管化。结论：初次眼部检查应在月经后 31 周或 4 周年龄（以较晚者为准）进行。当出现 3 个体征中的任何一个时，可以停止急性期 ROP 筛查，表明 ROP 导致视力丧失的风险很小或已通过。
Background: The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) demonstrated the efficacy of treatment for threshold ROP and indicated the need for worldwide ROP screening. Previous guidelines for ROP screening have been largely based on clinical impression; we can now develop evidence-based screening recommendations.Objective: To define the appropriate ages and retinal ophthalmoscopic signs that determine when to commence and conclude acute phase ROP screening.Design: Analysis of data from 2 prospective randomized controlled trials: CRYO-ROP (January 1, 1986, to November 30, 1987) and Light Reduction in ROP (LIGHT-ROP) (July 1, 1995, to March 31, 1997).Setting: Neonatal intensive care units in 23 study centers in the United States for CRYO-ROP and 3 centers for LIGHT-ROP.Patients: Eyes were examined sequentially in 4099 infants with birth weight less than 1251 g (CRYO-ROP study) and in 361 infants with birth weight less than 1251 g and gestational age less than 31 weeks (LIGHT-ROP study).Results: In 99% of infants, retinal conditions indicating a risk of poor outcome were not observed before 31 weeks' postmenstrual age or 4 weeks' chronologic age. Signs indicating that the risk of visual loss from ROP was minimal or had passed were the infant's attainment of 45 weeks' postmenstrual age without the development of prethreshold ROP or worse, progression of retinal vascularization into zone III without previous zone II ROP, and full vascularization.Conclusions: The initial eye examination should be conducted by 31 weeks' postmenstrual age or 4 weeks' chronologic age, whichever is later. Acute phase ROP screening can be discontinued when any of the 3 signs is present, indicating that the risk of visual loss from ROP is minimal or passed.