Abstract

P 023

Visual and structural outcome of zone 1 retinopathy of prematurity

Šenková K., Autrata R., Řehůřek J.
Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University Hospital, Brno, Czech Republic

Objective: Patients with zone 1 retinopathy of prematurity (ROP) have poor functional outcomes despite treatment. We evaluate and describe the clinical characteristics and treatment outcome in a series of patients pre-threshold and threshold zone 1 ROP.
Methods: Authors performed a retrospective analysis of 80 infants with zone 1 ROP (145 eyes) treated bettween 1993 and 2005 with diode laser. We recorded gestation period, birthweight and the presence of systemic complications. We also noted the time of the first examination, time of the first treatment and modalities of treatment used. The main outcomes were the structural outcome of the retina and visual acuity (VA). An unfavourable structural outcome was a posterior fold, a retinal detachment involving the posterior pole or the presence of a retrolental mass that obstructed the view of the retina. Visual acuity was also classified as favourable or unfavourable.
Results: The follow-up period for all surviving children was in range from 1.5 to 12 years. The mean gestational period was 26.4 weeks (range 23 -29 weeks). Mean gestational age at treatment was 33.8 weeks (range 29 – 36 weeks). The average birthweight was 786 g (range 585–1050 g). Eighty-seven of 145 eyes (60%) with zone 1 ROP had unfavourable retinal structural outcomes. Unusual signs such as a demarcation vessel between vascular and avascular retina and excessive intraretinal neovascularization were observed in zone 1 eyes. Only 58 eyes (40%) with zone 1 ROP, treated before the onset of threshold disease had favourable outcomes. An unfavourable visual outcome was one recorded as falling into the poor vision or blind categories. 95 of 145 eyes (66%) had unfavourable visual outcomes – best corrected visual acuity worse than 6/60 at final visit and 39 eyes (27%) remaining totally blind. 90% of children in our series had developmental delay or neurological disability.
Conclusions: Zone 1 retinopathy of prematurity has a very poor visual and anatomical prognosis. Special attention should be given to atypical morphology present in zone 1. Earlier treatment, before threshold disease occurred, may improve the structural and visual outcome.

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