Outcome of retinopathy of prematurity patients following adoption of revised indications for treatment.

BACKGROUND: The Early Treatment for Retinopathy of Prematurity study (ETROP), published in 2003, established new guidelines for treatment of retinopathy of prematurity (ROP) and demonstrated improved outcomes compared to previous guidelines. We examined outcomes before and after implementing the ETROP recommendations. METHODS: A retrospective chart review was performed using records of infants who had laser ablations for ROP performed from January, 2000 through December, 2005. Data collected included date of birth; birth weight; estimated gestational age (EGA); grading of ROP; date of laser ablation; and outcome of laser surgery. Univariate association with threshold or prethreshold treatment (Pre-ETROP and Post-ETROP, respectively) were assessed using t-tests or Wilcoxon tests. Additional comparison between groups was performed using Fisher's exact tests. RESULTS: 581 patients were examined before and 464 after December 2003. Of these, 29/581 (5% - Pre-ETROP Group) and 53/464 (11% - Post-ETROP Group) patients advanced to criteria requiring laser treatment respectively (P = 0.0001). The average estimated gestational age (EGA) at birth was 26.3 and 25.2 weeks, with an average birth weight of 888 and 707 grams for Pre and Post-ETROP Groups, respectively. Stage 5 retinal detachment (RD) developed in 10.3% of eyes in the Pre-ETROP Group and 1.9% of eyes in the Post-ETROP Group (P = 0.02). CONCLUSION: After the ETROP guidelines were implemented, there was a decrease from 10.3% to 1.9% of eyes developing Stage 5 retinal detachment, despite this group having a lower average EGA and lower average birth weight. These results underscore the importance of adoption of the Revised Indications.

Adult onset buphthalmos in a patient with marfan syndrome.

PURPOSE: To report a Marfan patient with an adult onset of buphthalmos. DESIGN: Observational case report. METHODS: Review of clinical, photographic, and ultrasound data of a 20-year-old Marfan patient who underwent an intraocular lens implantation complicated by late retinal detachment, chronic hyphema, and elevated intraocular pressure (IOP). RESULTS: A 6-month period of IOP between 25 and 30 mm Hg resulted in a 3.75 mm increase in axial length, a 1-mm increase in corneal diameter, and a 2 mm increase in exophthalmos. CONCLUSIONS: Buphthalmos secondary to long-term ocular hypertension can occur in an adult patient with Marfan syndrome presumably because of abnormal collagen structure. Thus, Marfan patients with high IOP should be treated aggressively to avoid optic nerve damage and other anatomic and structural changes.