Visual And Refractive Outcomes Of A Protocol Based Management For Zone 1 Retinopathy Of Prematurity. The Indian Twin Cities ROP Screening

1. Manjushree Bhate¹
2. Siddharth Kesarwani²
3. Padmaja .K.Rani³
4. Subhadra Jalali⁴

¹Consultant Pediatric Ophthalmologist LV Prasad Eye Institute Hyderabad India
²Consultant Pediatric Ophthalmology LV Prasad Eye Institute Bhubaneshwar India
³Consultant Retina services LV Prasad Eye Institute Hyderabad India
⁴Head Retina services LV Prasad Eye Institute Hyderabad India

PURPOSE
To determine visual and refractive outcomes in cases of Zone I Retinopathy of prematurity(ROP) treated with Laser Indirect Ophthalmoscope.

METHODS
The Indian Twin City ROP Screening (ITCROPS) prospective database was analysed for visual and refractive outcomes of Zone 1 Aggressive posterior Retinopathy of Prematurity (APROP). The protocol includes early screening (between 20 to 30 days of life), aggressive laser, under topical anaesthesia, to all avascular retina including the posterior avascular pockets in multiple sittings at 2-3 days intervals. It also includes regular followup for Teller Visual acuity and cycloplegic refractions.

RESULTS
90 eyes of 45 lasered patients were analysed. Mean gestational age was 29.52 weeks and mean birth weight 1.25 grams. Mean post conceptual age at treatment was 35.32 weeks.
The mean followup was 45.86 months(range 3-72 months).
In 19 patients the mean Snellen visual acuity in Right Eye was 20/77.3 (range 20/30 to 20/200)and in Left Eye was 20/57.6(range 20/30 to 20/200) and in 20 patients Teller visual acuity in Right eye was 20/200(range 20/11 to 20/960) in left eye was 20/180(range 20/11 to 20/960) five patients had unrecordable vision in both eyes,one patient had unrecordable vision only in right eye and one only in left eye less than 20/2700 on Teller cards
The mean spherical equivalent in Right eye was --4.71D (range +2.5 to -15.0) and in Left eye was -6.62D (range +2 to -13.87) at the last visit.
Trends of changing visual acuity and refraction over period of followup will be discussed.
18 patients had good vision in both eyes and six had blindness as per WHO vision categories.

CONCLUSION
Contrary to some reports, an aggressive protocol based approach for APROP can result in good visual outcomes in a majority of the treated eyes. Moderate to high myopia was common and few eyes needed amblyopia treatment.