Practice Patterns in Retinopathy of Prematurity Treatment for Disease Milder Than Recommended by Guidelines.
Practice Patterns in Retinopathy of Prematurity Treatment for Disease Milder Than Recommended by Guidelines.
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DOI：
10.1016/j.ajo.2015.12.005
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发表时间：
2016-03
影响因子：
4.2
通讯作者：
Imaging & Informatics in ROP Research Consortium
中科院分区：
文献类型：
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作者：
Gupta MP;Chan RVP;Anzures R;Ostmo S;Jonas K;Chiang MF;Imaging & Informatics in ROP Research Consortium
为了描述专家治疗早产儿视网膜病变（ROP）的频率和临床适应症，该疾病比1型疾病轻，1型疾病是公认的共识指南中推荐的治疗阈值。描述性分析设置：多中心。研究人群：一个包含1444只眼睛的数据库，前瞻性地从在6个主要ROP中心之一进行ROP筛查的所有婴儿中生成，这些婴儿的父母提供了知情同意书。干预：对数据库和图表进行回顾性审查，以确定所有接受轻度于1型ROP治疗的患者。主要结局指标：治疗适应症。对70例137眼ROP患儿进行了治疗。在这137只眼中，尽管临床诊断比1型ROP轻，但仍有13只（9.5%）接受了治疗。治疗适应症包括：活动性ROP，对侧眼接受1型ROP治疗（2眼，15.4%）;关于结构变化（9眼，69.2%），包括切线牵引伴颞叶血管拉直，涉及黄斑牵引（8眼，61.5%）和厚的3期膜，前后牵引涉及进展到4期ROP（3眼，23.1%）;在月经后期年龄较大时持续性ROP（4眼，30.8%）;和/或玻璃体积血（3眼，23.1%）。这项研究中的专家偶尔会建议治疗疾病小于1型ROP的眼睛。这项研究具有重要的临床意义，并强调了个体临床判断在循证治疗指南未涵盖的情况下的作用。
To characterize the frequency of and clinical indications for which experts treat retinopathy of prematurity (ROP) milder than Type 1 disease, the recommended threshold for treatment from established consensus guidelines. Descriptive analysis Setting: Multicenter. Study Population: A database of 1444 eyes generated prospectively from all babies screened for ROP at one of 6 major ROP centers whose parents provided informed consent. Intervention: Retrospective review of the database and charts to identify all patients treated for ROP milder than Type 1. Main Outcome Measure: Indication(s) for treatment. 137 eyes of 70 infants were treated for ROP. Of these 137 eyes, 13 (9.5%) were treated despite a clinical diagnosis milder than Type 1 ROP. Indications for treatment included: active ROP with the fellow eye being treated for Type 1 ROP (2 eyes, 15.4%); concerning structural changes (9 eyes, 69.2%), including tangential traction with temporal vessel straightening concerning for macular dragging (8 eyes, 61.5%) and thick stage 3 membranes with anteroposterior traction concerning for progression to stage 4 ROP (3 eyes, 23.1%); persistent ROP at an advanced postmenstrual age (4 eyes, 30.8%); and/or vitreous hemorrhage (3 eyes, 23.1%). Experts in this study occasionally recommended treatment in eyes with disease less than Type 1 ROP. This study has important clinical implications and highlights the role of individual clinical judgment in situations not covered by evidence-based treatment guidelines.