Evaluation of the outcomes and regression rate after early treatment for retinopathy of prematurity treatment in King Chulalongkorn Memorial Hospital

Abstract

Primary objectives: To study the unfavorable outcomes and assess the regression rate after early treatment protocol for the ROP in KCMH. - Secondary objectives: To study the complications and evaluate the progression and recurrence of ROP requiring retreatment after early treatment protocol for the ROP in KCMH. To identify the independent risk factor for the Retinopathy of Prematurity development in KCMH. - Design: The Retrospective descriptive study and retrospective cohort study. - Participants: The study included all premature infants who were screened ROP in King Chulalongkorn Memorial Hospital from January 2009 to January 2014. - Method: The data retrieved from the medical records (IPD & OPD) of all infants who screened for ROP at ROP clinic, NICU and prematurity unit from January 2009 to January 2014 at King Chulalongkorn Memorial Hospital (KCMH). The data were collected 4 parts: general data, ANC data and peri-/post- natal complication, ROP associated data, Sequelae and outcomes. The maternal and infant risks data use to analyse the association of ROP development between ROP group and no ROP group. The early treatment protocol for the ROP treatment in KCMH group (the stage 3 ROP in any zone and any plus and could not be compatible with prethreshold type 1 ROP and threshold ROP) was compare the unfavorable outcomes, regression rate, complications, progression and recurrence of ROP with the previous standard treatment (Prethreshold type 1 ROP) in KCMH group. - Main Outcome and Measures: The unfavorable outcomes and the regression rate after the early treatment protocol for ROP. - Result: The unfavorable outcomes after ROP treatment in KCMH occur 6 eyes from 28 eyes (21.43%) in the prethreshold type 1 ROP group but no unfavorable outcomes in the early treatment protocol group (63 eyes). There were statistically significant in difference between 2 groups (P=0.001).The early treatment protocol group in KCMH who treated with laser LIO (63 eyes) found 100 % of regression rate after the treatment, while the prethreshold type 1 ROP among 26 eyes were treated with laser LIO found 88.46 % of regression rate (23 eyes) and 11.54 % of non-regression (3 eyes). There were 2 eyes from 1 preterm infant who was treated with combination between laser LIO and IVT Bevacizumab found that that the non-regression after treatment was 100%. The recurrence of neovascularization after regression ROP and requiring re-treatment occur in 2 eyes (7.14%) of the prethreshold type 1 ROP group, but no recurrence in the early treatment group. There were not statistically significant in difference between 2 groups (P=0.092). The progression after ROP treatment without regression ROP occur 3 eyes (10.71%) in the prethreshold type 1 ROP group, but no progression in the early treatment group. There were statistically significant in difference between 2 groups (P=0.027). Bodyweights (BW), IVH and gestational ages (GA) were significantly associated with ROP development. - Conclusion: The early treatment protocol for the ROP in KCMH significantly reduced the unfavorable outcomes and increased the regression rate when compare with the previous standard early treatment of Retinopathy of Prematurity in the prethreshold type 1 ROP. Moreover, the early treatment protocol for Retinopathy of Prematurity in KCMH significantly reduced the recurrence and progression after treatment with the low complications.