Laser-ranibizumab treatment for retinopathy of prematurity in umbral-preumbral disease. Three years of experience.

BACKGROUND: The "Early Treatment for Retinopathy of Prematurity Cooperative" reported a failure rate of 55.2% using laser in zone 1 for treatment of retinopathy of prematurity (ROP). We need to offer better alternatives for those patients. We undertook this study to evaluate the efficacy of combined laser-ranibizumab therapy for ROP with threshold-prethreshold and "plus disease" and to study development of the newborn. METHODS: This is a prospective, experimental, longitudinal and open study including newborns of either <32 weeks of gestation or with a birth weight <1500 g, with threshold-prethreshold retinopathy or "plus disease." The effect of treatment was analyzed and development of the newborn was determined. RESULTS: We studied 34 eyes of 17 patients. Age at birth was 29.9 ± 2.6 weeks. Birth weight was 1,120 ± 253 g. The statistics demonstrated an important relationship between severity of retinopathy and early birth age, along with a high probability of threshold-prethreshold disease at 29.4 weeks of age or 1204 g birth weight. The Bayley scale reported normal development in 23.5% of cases, global retardation in 23.5%, psychomotor retardation but normal mental behavior in 29.4%, and mental retardation but normal psychomotor development in 23.5%. We demonstrated regression of retinopathy in all cases. Persistence of vascular tortuosity was present in 17.6% of cases without vascular dilatation, and vitreous membrane development was demonstrated in 11.7% of patients. CONCLUSIONS: Laser-ranibizumab treatment has allowed a better control of retinopathy for threshold-prethreshold and "plus disease" in this group of patients.

[Prevalence of premature retinopathy. 12-year detection in hospital "20 de Noviembre"]. / Prevalencia de retinopatía del prematuro. 12 años de detección en el Centro Médico 20 de Noviembre.

BACKGROUND: We undertook this study to determine the prevalence of premature retinopathy in a third level care hospital. METHODS: We carried out a descriptive, observational, longitudinal and prospective study from March 1991 to February 2004, including newborns with low birthweight of <1500 g and <35 weeks of gestation, evaluating the peripheral retina under pharmacological midryasis weekly during 4 weeks starting the 4th week of extrauterine life. The ROP international classification was used. RESULTS: Within our 12-year study, 2558 children were born, 62% were full term and 38% were premature. From 735 live premature births, 170 fulfilled inclusion criteria: 42% (72) did not present changes regarding retinopathy with a prevalence of 9.79, 46% (78) were in stages I-III with a prevalence of 10.61, and 12% (20) were in umbral stage with a prevalence of 2.72%. CONCLUSIONS: The prevalence of premature retinopathy in a third level hospital was 10.61% in stages I-III and 2.72% in umbral stage. This has allowed the evaluation of the peripheral retinal and the ability to plan treatment in the umbral stage to prevent future complications of blindness from disease progression in these cases.