Managing of retinopathy of prematurity in a tertiary center

Introduction: Retinopathy of prematurity is a complication of prematurity whose risk factors are well known. its prognosis remains fearsome and its treatment is difficult. Patients and methods: Fifty-four children were managed (108 eyes analyzed) for retinopathy of prematurity in the Ophthalmology Ward of Necker-Enfants-Malades Hospital between 1996 and 2002. A retrospective review of those cases was performed to describe their clinical features, their treatment and their outcome. Results: Mean gestational age was 26.75 weeks after the mother's last period (24-32.5 weeks) and mean birth weight was 842g (530-2260g). Stage zero occurred in ten eyes, stage 1 in two eyes, stage 2 in seven eyes, stage 3 in 42 eyes, stage 4 in ten eyes, stage 5 in 24 eyes, and after-effects stage in 13 eyes. Initial treatment (combined treatments possible) was abstention in 45 eyes, cryotherapy in 16 eyes, laser photocoagulation in 43 eyes, surgical treatment of 13 eyes (scleral buckling or vitrectomy). Cryotherapy was effective in 71.5% of cases, photocoagulation was effective in 77%, and scleral buckling was effective in 25%. Vitrectomy failed in the five eyes treated. Outcome was complicated by legal blindness in 33 eyes. Discussion and conclusion: The cases of retinopathy of prematurity that we manage are often severe, stage 3 or above, which explains the outcome of the patients. The 7-year experience reported herein shows how difficult it is to manage this condition, though the need for its detection, diagnosis criteria, and therapeutical indications are well known. Because younger and smaller premature newborns are successfully managed by pediatricians, retinopathy of prematurity is far from having vanished and its morbidity is considerable.