Partial retinal detachment at 3 months after threshold retinopathy of prematurity. Long-term structural and functional outcome. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity Cooperative Group
W. S. Gilbert, G. E. Quinn, V. Dobson, J. Reynolds, R. J. Hardy and E. A. Palmer
Department of Ophthalmology, Children's National Medical Center, Washington, DC, USA.
OBJECTIVE: To investigate the structural and functional outcome at age 4
1/2 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 1/2 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 1/2 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 unrecordable 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 1/2 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 1/2 years are related to the extent of RD
and the involvement of the fovea at 3 months.
