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Long-term Structural and Functional Outcome

William S. Gilbert, MD; Graham E. Quinn, MD; Velma Dobson, PhD; James Reynolds, MD; Robert J. Hardy, PhD; Earl A. Palmer, MD; Multicenter Trial of Cryotherapy for Retinopathy of Prematurity Cooperative Group

Arch Ophthalmol. 1996;114(9):1085-1091.

Abstract
Objective
To investigate the structural and functional outcome at age 4 years of eyes that had partial retinal detachment (RD) at 3 months after the occurrence of threshold retinopathy of prematurity; these eyes were involved in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study.

Methods
Of the 531 eyes in the randomized portion of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study, 61 had partial RD at the 3-month examination. The extent of retinal involvement was recorded, and the presence of a foveal detachment was noted. At the examination conducted at age 4 years, the fundus structure was graded into cicatricial retinopathy of prematurity outcome categories by study ophthalmologists, and the visual acuity was measured by masked examiners using the Teller Acuity Card procedure and the crowded HOTV recognition acuity test.

Results
Of the 61 eyes, 7 eyes continued to have partial RD at age 4 years. Of the remaining eyes, 20 eyes had structural outcomes classified as favorable in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study, and 27 eyes had unfavorable structural outcomes. Data were un-recordable for 3 eyes and missing for 4 eyes. No difference in outcome was found for eyes with partial RD at 3 months that had undergone cryotherapy vs eyes that had served as controls. Only 6 eyes had a visual acuity better than 20/200. When partial RDs did not involve the fovea at 3 months, structural and functional outcomes at 4 years were better than when RDs involved the fovea. The best predictor of outcome was the extent of RD at 3 months.

Conclusions
Partial RD present 3 months after threshold retinopathy of prematurity is unstable anatomically, and the visual outcome is generally poor. Structure and function at 4 years are related to the extent of RD and the involvement of the fovea at 3 months.

Author Affiliations
From the Department of Ophthalmology, Children's National Medical Center, and the George Washington University School of Medicine and Health Sciences, Washington, DC (Dr Gilbert); Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia and Scheie Eye Institute, University of Pennsylvania, Philadelphia (Dr Quinn); Departments of Ophthalmology and Psychology, University of Arizona, Tucson (Dr Dobson); Department of Ophthalmology, Children's Hospital of Buffalo, University of Buffalo, Buffalo, NY (Dr Reynolds); University of Texas Health Science Center at Houston, School of Public Health (Dr Hardy); and the Casey Eye Institute, Oregon Health Sciences University, Portland (Dr Palmer).

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