Retinopatia da prematuridade: análise de uma tentativa de redução de danos / Retinopathy of prematurity: analysis of a damage reduction attempt

Resumo Objetivo: Avaliar a eficácia de um protocolo de redução da saturação do oxigênio utilizado na suplementação dos recém-nascidos pré-termos (RNPT) internados em uma UTI neonatal para prevenir o aparecimento da Retinopatia da prematuridade (ROP). Métodos: Trata-se de estudo de coorte realizado em única UTI Neonatal. O primeiro grupo (pré-protocolo, n=30) fez uso de oxigênio com saturação de hemoglobina >95%. A partir da instituição de um novo protocolo de oxigenioterapia que manteve a saturação de hemoglobina entre 90% e 95% obteve-se o segundo grupo (pós-protocolo n=28). Todos os RNPT incluídos tinham idade gestacional de menor ou igual 32 semanas e/ou com peso de nascimento igual ou abaixo de 1500g, fizeram mapeamentos de retina a partir de 28 dias de vida e seguimento por até 45 semanas de idade gestacional corrigida. Resultados: Dos 58 casos estudados, excluindo-se os que foram a óbito (15/58; 26,8%) dos casos, ROP foi diagnosticado em 15/43 (34,9%) pacientes. A menor idade gestacional influenciou significativamente no aparecimento da ROP (p=0,002). Em relação ao número de casos de ROP e de óbitos não se observou diferença estatisticamente significativa entre os grupos. O tempo de oxigenioterapia foi significativamente associado com a presença de ROP em ambos grupos. Meninos foram seis vezes mais acometidos por ROP que as meninas. Conclusão: A redução da saturação de oxigênio não se mostrou eficaz para redução de número de casos de ROP.

Abstract Objective: To evaluate the efficacy of an oxygen saturation reduction protocol used to supplement preterm newborns (PTNB) hospitalized in a neonatal ICU to prevent the onset of retinopathy of prematurity (ROP). Methods: This is a cohort study performed in a single Neonatal ICU. The first group (pre-protocol, n = 30) used oxygen with hemoglobin saturation > 95%. Since the institution of a new oxygen therapy protocol that maintained hemoglobin saturation between 90% and 95%, the second group was obtained (post-protocol n = 28). All included preterm infants had a gestational age of less than or equal to 32 weeks and / or birth weight of 1500 g or less, retinal mappings from 28 days of life and follow up for up to 45 weeks of corrected gestational age. Results: 58 cases were studied, excluding those who died (15/58; 26.8%), ROP was diagnosed in 15/43 patients (34.9%). The lower gestational age significantly influenced the appearance of ROP (p = 0.002). Regarding the number of ROP cases and deaths, no statistically significant difference was observed between groups. Oxygen therapy time was significantly associated with the presence of ROP in both groups. Boys were six times more affected by ROP than girls. Conclusion: Reduction of oxygen saturation was not effective in reducing the number of cases of ROP.

Retinopathy of prematurity.

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina that occurs in premature and low birth weight babies. Stages of ROP are 1, 2, 3, 4A, 4B and 5. There are three zones I, II and III. Screening is essential to detect ROP. Whom, when and how to screen ROP has been narrated in a nutshell. Once threshold ROP is detected, it is essential to treat within 72 hours. Retinal ablation of the avascular retina is done using laser photocoagulation or cryotherapy. Rush disease is primarily a zone I ROP with extraretinal proliferation. It requires aggressive laser treatment with larger number of high intensity closely applied spots to stop the progression. Surgical management is advocated in stages IVA and IVB ROP by scleral buckling. Stage V requires complex vitreoretinal surgery. It is important to promote awareness about the disease and to ensure timely management to prevent blindness.

Retinopatia da prematurldade / Retinopathy of prematurity

Os autores fazem uma revisão sobre Retinopatia da Prematuridade (ROP), abordando diagnóstico, classificação, prevenção de doença, seguimento de casos e particularidades de seu tratamento

Retinopathy of prematurity--screening and management.

Retinopathy of prematurty (ROP) is a relentless disease of the retina in premature children that in advanced cases leads to blindness. A good screening programme ensures early detection and timely intervention. Surgical results in advanced stages of ROP are very poor. Creating awareness, training of specialists end development of viable ROP centres is an urgent need. New research insights have shown promise to prevent, detect and treat ROP.

Surgery for stage 5 retinopathy of prematurity: the learning curve and evolving technique.

PURPOSE: To describe our experience with management of eyes with stage 5 retinopathy of prematurity (ROP). METHODS: Closed vitreoretinal surgery was done on 96 eyes of patients with stage 5 ROP. Lens was sacrificed in all but one eye. Surgery involved an attempt to clear all preretinal tissue and open the peripheral trough all round. In most instances bimanual surgery under viscoelastic was performed. RESULTS: At last follow up, anatomical success (defined as attached posterior pole) was achieved in 22.5% cases. Significant postoperative problems included reproliferation and secondary glaucoma. Only two infants obtained mobile vision. CONCLUSION: Late identification of disease, lack of prior treatment such as laser or cryo, and higher incidence of narrow-narrow funnel configuration were responsible for the poor surgical results noted in this series. The poor surgical and functional results reemphasize the need for prompt screening and management of infants at risk.

Retinopatía del prematuro / Retinopathy of prematurity

Se realizó una revisión de la literatura acerca de la retinopatía del prematuro (RDP), su definición, epidemiología, factores de riesgo de presentación, clasificación internacional, cuadro clínico, patogénesis, diagnóstico, historial natural, pronóstico y tratamiento. Se revisaron también los reportes del estudio multicéntrico de tratamiento con crioterapia de la RDP. Se concluye que es de gran importancia conocer las alteraciones provocadas por este padecimiento, así como realizar el diagnóstico y tratamiento oportunos, para así evitar las secuelas que muchas veces llevarán al paciente a la ceguera

Prevalencia da retinopatia da prematuridade em recem-nascidos de muito baixo peso / Prevalence of retinopathy of prematurity in very low birth weight infants

Objetivo: Determinar a prevalência da retinopatia da prematuridade (RP) em recém-nascidos de muito baixo peso (RN-MBP) (P<1500g). Métodos: Foram examinados prospectivamente 102 RN-MBP admitidos no BA M-HC (FMUSP), nascidos no período de 01 de janeiro de 1992 a 31 de dezembro de 1993. O mapeamento de retina, com depressäo escleral, foi realizado inicialmente entre 3 a 8 semanas de vida pós-natal e repetido a cada 1 a 4 semanas, até que a vascularizaçäo da retina se completasse ou a RP se estabelecesse. Para a classificaçäo da RP, foram utilizados os critérios da "International Classification of ROP", e, para análise estatística, considerou-se a retinopatia mais grave que o RN apresentou na sua evoluçäo. Resultados: Nesta casuística, verificou-se RP em 29,90 por cento dos casos, em 78,5 por cento dos RN com peso inferior a 1.000g. e em 72,73 por cento dos RN com idade gestacional inferior a 30 semanas...

Retinopathy of prematurity: incidence and risk factors.

OBJECTIVE: To determine the incidence of Retinopathy of Prematurity (ROP) in high risk babies admitted to the neonatal unit and to study risk factors for it's development. DESIGN: Prospective cohort study. SETTING: Level II Neonatal Intensive Care Unit. SUBJECTS: 100 babies admitted to the neonatal unit during a 4 year period who were below 1500 g or whose gestation was < or = 34 weeks. METHODS: Examination of the eye was done in the neonatal unit or in the neonatal follow up clinic by an Ophthalmologist by indirect Ophthalmoscopy at 4-6 weeks postnatal age. RESULTS: The incidence of ROP was 46%. Of the 100 babies screened, 21 had stage I, 14 had stage II, 8 had stage III and 3 had stages IV and V. The incidence of ROP was 73.3% among < 1000 g babies and 47.3% among < 1500 g babies. The incidence of ROP among 28-29 weeks, 30-31 weeks and 32-33 weeks babies was 83%, 60% and 50%, respectively. The maximum stage of ROP developed between 37-42 weeks post conceptional age in 69% subjects. On univariate analysis, gestation < or = 32 weeks, anemia, Blood transfusions, apnea and exposure to oxygen significantly increased the risk of developing ROP. On multivariate logistic regression analysis, anemia and duration of oxygen therapy were the significant independent predictors of development of ROP. Nine of the 46 babies underwent cryotherapy for threshold ROP. CONCLUSION: The incidence of ROP among high risk babies is significant and duration of oxygen therapy and anemia are independent factors predicting the development of ROP. All high risk babies should be screened for ROP. Cryotherapy is a relatively simple procedure which can be done in the neonatal unit.

Vitamina E no tratamento da retinopatia do prematuro (ROP)? / Vitamin E in the treatment of retinopaty of prematurity

O presente trabalho por objetivo discutir os aspectos mais importantes e atuais com relaçäo à etiologia, fatores de risco, classificaçäo, problemas associados e tratamento da ROP, especialmente questionando o uso de vitaminas E