Intervention Review

Peripheral retinal ablation for threshold retinopathy of prematurity in preterm infants

  1. Chad Andersen1,*,
  2. Dale Phelps2

Editorial Group: Cochrane Neonatal Group

Published Online: 26 JUL 1999

Assessed as up-to-date: 9 MAY 1999

DOI: 10.1002/14651858.CD001693


How to Cite

Andersen C, Phelps D. Peripheral retinal ablation for threshold retinopathy of prematurity in preterm infants. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD001693. DOI: 10.1002/14651858.CD001693.

Author Information

  1. 1

    Children's Youth and Women's Health Service, Department of Perinatal Medicine, North Adelaide, SA, Australia

  2. 2

    University of Rochester, Pediatrics and Ophthalmology, New York, 14642, USA

*Chad Andersen, Department of Perinatal Medicine, Children's Youth and Women's Health Service, 72 King William Road, North Adelaide, SA, 5006, Australia. chad.andersen@cywhs.sa.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JUL 1999

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

This section is under preparation and will be included in the next issue.

Objectives

In premature infants with threshold retinopathy of prematurity (ROP) does peripheral retinal ablation, by any means, reduce the incidence of adverse ophthalmic outcome?

Search methods

The standard search strategy of the Cochrane Neonatal Review Group was used. This included a search of the Cochrane Neonatal Group Register of Clinical Trials, MEDLINE, EMBASE, previous reviews including cross references, abstracts from pediatric and ophthalmologic meetings, letters and expert informants. Search terms included "Retinopathy of Prematurity" [MeSH Terms], "Retrolental Fibroplasia" [All Fields] and "Lightcoagulation" [All Fields] or "Cryosurgery" [All Fields]. In addition, a personal bibliographic database was used as a cross-reference.

Selection criteria

All trials in human premature infants with threshold ROP utilizing random or quasi random allocation to either peripheral retinal ablation of the avascular retina, by any means, or concurrent control group with independent outcome assessment were initially selected for review. Following methodologic review, only studies using random allocation were selected for data extraction.

Data collection and analysis

Relevance and validity were assessed by the two authors and consensus reached. Each author extracted clinical outcomes from valid reports independently. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group.

Main results

Two randomised trials were identified. Data from these studies show that peripheral retinal ablation reduces the risk of (1) early unfavorable retinal structure from 47.9% to 28.1% (absolute risk reduction 19.8% [95% CI 27.9 - 11.8%]), (2) unfavorable retinal structure in early childhood from 44.3% to 26.3% (absolute risk reduction 18% [95% CI 27.0 - 9.1%]) and (3) unfavorable visual acuity in early childhood from 63% to 50.6% (absolute risk reduction 12.2% [95% CI 21.2 - 3.1]). In addition, visual fields in sighted eyes were slightly smaller in the treated (51.3° ± 11.8°) group as compared to the control (58.2°± 14.5°) group.

Authors' conclusions

Peripheral retinal ablation reduces the incidence of adverse ophthalmic outcome in premature infants with threshold ROP. In sighted eyes, peripheral retinal ablation may reduce the size of the visual field. At this stage, long term outcomes remain unknown.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Peripheral retinal ablation for threshold retinopathy of prematurity in preterm infants

Advances in perinatal medicine have led to increased survival of extremely low birth weight infants and an increase in the incidence of retinopathy of prematurity (ROP). This is a vascular proliferative disorder of the immature retina in premature infants that can result in impairment of vision and a high (> 47%) chance of blindness if untreated (threshold ROP). Normally the retina has a complete system of blood vessels by 40 weeks. Injury to the developing retinal capillaries occurring before or during birth and in the days following delivery stimulates new vascularization, which is the observable retinopathy. This can result in successful revascularization of the retina (regression of the ROP) or progression to neovascular membranes in the vitreous, subsequent scarring and retinal detachment. The incidence and severity of retinopathy is inversely related to gestational age. Treatment involves removal (ablation) of the part of the retina without blood vessels to preserve central macula vision. Cryoablation and laser techniques are used. The review authors identified two randomised trials involving 291 and 28 premature infants with threshold ROP, reported in the 1980s. Both used cryotherapy for peripheral retinal ablation, reducing the incidence of adverse ophthalmic outcomes. Unfavorable retinal structure at less than 12 months and in early childhood at 5½ years (234 infants) was reduced by some 18 to 20%. Therefore, the number of eyes with threshold ROP needed to treat (NNT) to avoid one unfavorable outcome is around five. The risk of poor visual acuity in early childhood was reduced from 63 to 51% (NNT 8).

The advantage of retinal ablation in these eyes outweighs short term morbidity associated with the therapy. This includes an increase incidence of apnoea and bradycardia both during the procedure and in the following one to three days. The visual fields in sighted eyes were slightly smaller in the group receiving cryoablation as compared to the control group. It is important to note that compared to normal, eyes with ROP that spontaneously recovered also had a reduction in visual field. At this stage, long term outcomes remain unknown.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於早產兒而言,為了已達閥質警戒之早產視網膜病變而進行之周邊視網膜燒灼術

本節還在準備當中,而且將會被收錄在下1期的內容裡面。

目標

在已達閥質警戒之早產視網膜病變(ROP)之早產兒身上,不管是以任何方式之周邊視網膜燒灼術是否可以降低眼科後遺症的發生率?

搜尋策略

使用Cochrane Neonatal Review Group標準搜尋策略,包含搜尋Cochrane Neonatal Group Register of Clinical Trials、MEDLINE、EMBASE、先前文獻回顧:包含交互參照、兒科及眼科研討會摘要、信件、以及專家資訊。搜尋的詞彙包括 ‘Retinopathy of Prematurity’ [MeSH名詞]、 ‘Retrolental Fibroplasia’ [全領域]以及 ‘Lightcoagulation’ [全領域]]或 ‘Cryosurgery’ [全領域]]。此外並利用個人書目資料庫交互參照。

選擇標準

對於已達閥質警戒之ROP之人類早產兒而言,使用了隨機或是半隨機的分配方式之後,不管採取任何方式來對無血管之視網膜進行了周邊視網膜燒灼術的那組,或是在同步進行並且又採取了獨立結果分析的對照組當中,所有的試驗都會初步被選進本篇回顧當中。在進行了方法方面的回顧之後,只有使用隨機分配的研究才會被挑選來進行資料擷取。

資料收集與分析

共有2位作者曾經評估過相關性與有效性,並且達成了共識。每1位作者都獨立地從有效的報告當中,擷取出臨床上的結果。然後,再根據Cochrane Neonatal Review Group中的標準來進行資料分析的工作。

主要結論

我們共確認了2份隨機化的試驗。從這些研究中所得到的資料顯示,周邊視網膜燒灼術可以降低下列項目的風險(1)將早期不利的視網膜結構從47.9% 降到28.1% (絕對風險下降率為19.8% 「95% CI 27.9 – 11.8% 」),(2)在兒童初期時之不利的視網膜結構從44.3% 降到26.3% (絕對風險下降率為18% 「95% CI 27.0 – 9.1% 」),以及(3)在兒童初期時之不利的視力敏銳度從63% 降到50.6% (絕對風險下降值為12.2% 「95% CI 21.2 – 3.1」)。此外,當跟對照組(58.2°±14.5°)進行比較的時候,發現在接受治療的那組(51.3°±11.8°)的視野範圍就顯得稍微小了點。

作者結論

對於患有已達閥質警戒之ROP之早產兒而言,周邊視網膜燒灼術可以降低眼科後遺症的發生率。但周邊視網膜燒灼術可能會讓視野範圍變得比較狹窄。在目前這個階段,長期之預後仍然是未知的。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

必須要再提出摘要