Original article
Anatomical and refractive outcomes in patients with treated retinopathy of prematurity
Resultados anatómicos y refractivos en pacientes tratados por retinopatía del prematuro
M. Lolasa, A. Tumaa, M. Zanollib,c,
, R. Agurtob,c, R. Stevensonb,c, D. Ossandónb,c
Corresponding author
a Facultad de Medicina Universidad del Desarrollo – Clínica Alemana de Santiago, Santiago, Chile
b Departamento de Oftalmología, Clínica Alemana de Santiago Facultad de Medicina Universidad del Desarrollo, Santiago, Chile
c Departamento de Oftalmología, Hospital de Niños Roberto del Río, Santiago, Chile
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Lolas, A. Tuma, M. Zanolli, R. Agurto, R. Stevenson, D. Ossandón" "autores" => array:6 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Lolas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Tuma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "M." "apellidos" => "Zanolli" "email" => array:1 [ 0 => "mario.zanolli@me.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "R." 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"apellidos" => "Ossandón" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Facultad de Medicina Universidad del Desarrollo – Clínica Alemana de Santiago, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Oftalmología, Clínica Alemana de Santiago Facultad de Medicina Universidad del Desarrollo, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital de Niños Roberto del Río, Santiago, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados anatómicos y refractivos en pacientes tratados por retinopatía del prematuro" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 757 "Ancho" => 991 "Tamanyo" => 98627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ocular fundus photograph showing posterior aggressive retinopathy with plus disease in 4 quadrants.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Retinopathy of prematurity (ROP) is a proliferative vascular disorder that could lead to legal blindness or severely impair vision in premature infants.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> At present, first line of treatment includes retinal photocoagulation with diode laser and intravitreal antiangiogenics. In most cases, early treatment could prevent negative results secondary to ROP.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2–4</span></a> However, treated patients could also experience secondarily results such as visual of acuity, refraction or recurrence.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The main objective of this study is to present the anatomical results of a series of patients treated for ROP. The secondary objective is to present the visual and refractive results of said group.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A multicenter,<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">b</span></a> prospective and observational study was carried out in compliance with the ethical principles of the Helsinki Declaration. The study included premature patients treated with laser photocoagulation or injections of antiangiogenics for treating ROP at the <span class="elsevierStyleItalic">Roberto del Río</span> Hospital. The study excluded treated patients who, at the time of closure of the study, did not have 6 months follow-up or missed regular checkups.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the basis of the treatment criteria established by ETROP 3, treatment was indicated for ROP type 1 (any stage of ROP with plus disease in zone <span class="elsevierStyleSmallCaps">I</span>, ROP in stage III in zone I without plus disease and ROP in stages 2 and 3 with plus disease in zone <span class="elsevierStyleSmallCaps">II</span>), threshold disease (stage 3 with more than 5 continuous hours or 8 discontinuous hours) or posterior aggressive retinopathy (BH-ROP) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> Patients with BH-ROP or retinopathies in posterior zone <span class="elsevierStyleSmallCaps">I</span> or zone <span class="elsevierStyleSmallCaps">II</span> were treated with antiangiogenics. The remaining cases were treated with laser. At surgery, all patients had ocular fundus documentation with RetCam 3 (Clarity Medical System, Pleasanton, CA, USA).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Treatments were performed by an ophthalmologist trained in ROP within 72<span class="elsevierStyleHsp" style=""></span>h from diagnostic. Laser treatment consisted in applying Nd:YAG 532-nm at a power of 180–400<span class="elsevierStyleHsp" style=""></span>mW utilizing half a separation space between dots. Antiangiogenic injections were administered with a paralimbar injection (0.5<span class="elsevierStyleHsp" style=""></span>mm) of bevacizumab, utilizing a dose of 0.625<span class="elsevierStyleHsp" style=""></span>mg (injection volume of 0.025<span class="elsevierStyleHsp" style=""></span>ml).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Demographic data and unfavorable anatomic results were considered, including retina detachment, retinal folds with macular compromise, tractional retrolental tissue, glaucoma, cataracts, hyphema and laser scars compromising the macula. After treatment, the patients were examined and followed by 2 ophthalmologists trained in ROP (D.O; M.Z). The patients were followed up according to the conventional screening criteria. After ROP regression, patients were checked at month one, 3 and 6 from treatment, evaluating cycloplegic refraction (45<span class="elsevierStyleHsp" style=""></span>min; use of 10<span class="elsevierStyleHsp" style=""></span>mg tropicamide [Mydriacyl 1%; Alcon, Fort Worth TX, USA], 25<span class="elsevierStyleHsp" style=""></span>mg phenylephrine chlorhydrate [Midfrin 2.5%; Alcon, Fort Worth, TX, USA], 2 applications at five-minute intervals) and ocular fundus. Subsequently, they were given appointments at 3-month intervals for the same assessments. Between follow-up month 6 and 12, visual acuity was measured with the Teller test. Data of both eyes of each patient were utilized for refractive comparison and statistical analysis. SPSS 16.0 was utilized for said purpose (SPSS Inc., Chicago, USA).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The treated group included 144 eyes of 72 patients. Of these, 49 were treated with photocoagulation and 23 with bevacizumab. One patient (1.4%) of the group treated with laser involved to 4<span class="elsevierStyleHsp" style=""></span>b retina detachment and required bilateral vitrectomy. Overall, 15 cases presented with ROP in zone <span class="elsevierStyleSmallCaps">I</span>, 13 in zone <span class="elsevierStyleSmallCaps">II</span> posterior and 44 in zone <span class="elsevierStyleSmallCaps">II</span>. Of all patients, 45 exhibited type I ROP, 16 exhibited threshold disease and 11 presented BH-ROP. The median of gestational age (GA) was 26 weeks (range 23–30) and the median weight at birth was 800<span class="elsevierStyleHsp" style=""></span>g (range 405–1350). The median follow-up was 10 months (range 6–28).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The median Teller test was 3.2 cycles/cm (range 0.32–13). In 16 cases (22%) myopia of -6D or greater was observed. Sphere median was −1.75 D (range −16.00 to +3.50 D). As regards cylinder, a median of 0.00 was observed (range −4.5 to +1.5 D). In 6 patients (8.3%) astigmatism above 2 D was observed. The spherical equivalent showed median of −0.5 D (range −16 to +3.50 D). Out of 145 eyes, 2 (1.4%) did not reach anatomic success (same patient, both eyes with retina detachment).</p><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic comparison, GA median, median weight at birth and refractive results between ROP type 1, threshold ROP and BH-ROP. When comparing ROP type 1 with threshold ROP, a statistically significant difference was found for post-treatment sphere (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007) and a tendency to GA (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06) and weight at birth (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.09), without finding differences in the remaining variables (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). When comparing ROP type 1 with BH-ROP groups, a statistically significant difference was found for the post-treatment sphere (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006) and GA (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01), in addition to a tendency to weight at birth (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.07), without differences in the remaining variables (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). A comparison between patients treated with laser and 2 with bevacizumab is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, where a statistically significant difference was found for GA (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and birth weight (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007), in addition to a tendency toward post-treatment sphere (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06), without finding differences in the remaining variables (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">At the end of the follow-up period, anatomic success was achieved in 71 out of 72 patients (98.6%).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The present study reports the anatomic and refractive results of a patient population treated for ROP, separating subgroups in ROP type 1, threshold ROP and BH-ROP. In this cohort, the anatomic result was favorable for the majority of patients (98.6%), whereas refractive results were comparable to those found in the literature.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In general, successfully treated ROP eyes exhibited a significant spherical refractive defect,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">.</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> which is more significant in more aggressive ROP subgroups (threshold and BH-ROP).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,10</span></a> Other studies reported that the prevalence of myopia is higher in treated groups, to the extent that patients with more aggressive ROP tend to exhibit higher prevalence of high myopia.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> Evidence also demonstrates that patients with ROP in zone <span class="elsevierStyleSmallCaps">I</span> treated with laser exhibit higher frequency of myopia and high myopia than those treated intravitreally.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> In the present study, the refractive result did not show statistically significant differences in the group treated with laser versus the one treated with antiangiogenics (even though a tendency with a p value of 0.06 was obtained). A comparative analysis between zones was not carried out because in posterior zones <span class="elsevierStyleSmallCaps">I</span> and <span class="elsevierStyleSmallCaps">II</span> all patients were given bevacizumab injections. The severity of the myopic spherical defect was significantly higher in patients with BH-ROP and threshold ROP. No association between ROP severity and astigmatism was found, which is comparable to the ETROP studies.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As in other studies, the present paper also reports a higher frequency of ROP in male patients<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,13</span></a> which does not have a clear explanation. Male prematures exhibit a higher frequency of hyaline membrane disease, which would point to a tendency toward higher oxygen requirements, a variable that was not measured in the present study.</p><p id="par0070" class="elsevierStylePara elsevierViewall">BH-ROP is characterized by its posterior location together with prominence of plus disease and a poorly defined stage.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> In contrast with other studies, all the patients with BH-ROP of this study were treated initially with intravitreal bevacizumab, the effectiveness of which has been demonstrated against laser for treating ROP in zone <span class="elsevierStyleSmallCaps">i</span>.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> However, as in patients with BH-ROP treated with laser, these also developed more significant spherical defects.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> A study demonstrated that, at one year follow-up, the use of bevacizumab was associated to less myopia and astigmatism than with the use of laser.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The present study exhibits limitations. Despite being a prospective study, it is not randomized and therefore the results of patients treated with bevacizumab and with laser cannot be compared. Even the indications for each treatment were for different patients. In addition, not all patients treated with intravitreal bevacizumab were examined with angiography after treatment. In contrast with patients treated with laser, the literature refers a significant frequent of ischemic angiographic alterations in patients treated with bevacizumab.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> This matches the experience of the present group, for which reason at present all patients treated with bevacizumab are given appointments for angiographic examination. Recurrence in this subgroup is not infrequent, making strict follow-up necessary. Knowledge of the incidence, recurrence, risk factor and critical recurrence periods enables adaptations in the clinical management of these patients.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion, primary treatment with laser or antiangiogenics is effective as it achieves anatomic success in the majority of patients. Regardless of the selected treatment, the high frequency of severe refractive defects make ophthalmological follow-up a crucial factor for obtaining the highest visual potential result for these patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors did not receive financial support and do not have commercial interests in the equipment.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres906139" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec886579" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres906138" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec886580" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-15" "fechaAceptado" => "2016-12-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec886579" "palabras" => array:3 [ 0 => "Retinopathy of prematurity" 1 => "Laser" 2 => "Bevacizumab" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec886580" "palabras" => array:3 [ 0 => "Retinopatía del prematuro" 1 => "Láser" 2 => "Bevacizumab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the anatomical and refractive outcomes after treatment with intravitreal bevacizumab or laser in a patient cohort with retinopathy of prematurity (ROP).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multicenter, prospective, and observational study was performed on patients with ROP treated at Hospital Roberto del Río. Those patients with less than 6<span class="elsevierStyleHsp" style=""></span>months of follow-up were excluded. Cases with posterior zone <span class="elsevierStyleSmallCaps">II</span>, zone <span class="elsevierStyleSmallCaps">I</span> ROP, and aggressive posterior ROP (AP-ROP) were treated with intravitreal bevacizumab. All other patients were treated with laser. Follow-up was performed every 3 months, and included fondo evaluation, refraction, and Teller tests.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The treated group included 144 eyes of 72 patients, of whom 49 were treated with laser and 23 with intravitreal bevacizumab. One (1.4%) patient from the laser group progressed to stage 4<span class="elsevierStyleHsp" style=""></span>b retinal detachment and required bilateral vitrectomy. Of the remainder, 45 cases had type 1 ROP, 16 had threshold disease, and 11 had AP-ROP. The median of gestational age was 26 weeks (range 23–30), and median of birth weight was 800<span class="elsevierStyleHsp" style=""></span>g (range 405–1350). Median follow-up was 10 months (range 6–8). The Teller test median was 3.2 cycles/cm (range 0.32–13). There were 16 (22%) cases with a myopic refraction of −6 D or more. The sphere median was −1.75 D (range −16.00 to +3.50 D) and the cylindrical median was 0.00 (range −4.5 to +1.5 D). Anatomical success was achieved in 71 (98.6%) of patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Treatment with laser or intravitreal bevacizumab is a highly successful primary treatment for ROP. Anatomical success can be achieved in most cases. Treated patients develop frequent and severe refractive defects, which should be corrected. Vision outcome, measured using the Teller preferential test, shows good results.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los resultados anatómicos y refractivos en un grupo de pacientes tratados por retinopatía del prematuro (ROP) con bevacizumab intravítreo o láser.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio multicéntrico, prospectivo y observacional. Se incluyó a pacientes tratados por ROP en el Hospital Roberto del Río. Los pacientes con menos de 6 meses de seguimiento fueron excluidos. Los pacientes con zona <span class="elsevierStyleSmallCaps">II</span> posterior, zona <span class="elsevierStyleSmallCaps">I</span> o retinopatía agresiva posterior (AP-ROP) fueron tratados con bevacizumab intravítreo. El resto fueron tratados con láser. El seguimiento fue hecho cada 3 meses, e incluyó fondo de ojo, refracción y test de Teller.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 144 ojos de 72 pacientes. Un total de 49 fueron tratados con láser y 23 con bevacizumab. Un caso (1,4%) tratado con láser progresó a un desprendimiento de retina etapa 4<span class="elsevierStyleHsp" style=""></span>b y requirió vitrectomía bilateral. Otros 45 casos tuvieron ROP de tipo 1; 16 enfermedad umbral y 11 AP-ROP. La mediana de edad gestacional fue de 26 semanas (rango 23-30) y la mediana de peso de nacimiento fue de 800<span class="elsevierStyleHsp" style=""></span>g (rango 405-1.350). La mediana de seguimiento fue de 10 meses (rango 6-28). La mediana del Teller fue de 3,2 ciclos/cm (rango 0,32-13). Del total, 16 casos (22%) presentaron miopía de −6 D o más. La mediana de la esfera fue de −1,75 D (rango −16,00 a +3,50 D) y la mediana del cilindro fue de 0,00 (rango −4,5 a +1,5 D). El éxito anatómico se logró en 71 pacientes (98,6%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con láser o bevacizumab intravítreo como tratamiento primario en ROP es altamente eficaz. El éxito anatómico se alcanzó en la mayoría de los pacientes. Los resultados visuales obtenidos por test de Teller muestran buenos resultados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Lolas M, Tuma A, Zanolli M, Agurto R, Stevenson R, Ossandón D. Resultados anatómicos y refractivos en pacientes tratados por retinopatía del prematuro. Arch Soc Esp Oftalmol. 2017;92:472–476.</p>" ] 1 => array:3 [ "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Antofagasta Hospital, Arica Hospital, Chillán Hospital, Coyhaique Hospital, Maipú Hospital, Punta Arenas Hospital, Rancagua Hospital, Talca Hospital, Félix Bulnes Hospital, Gustavo Fricke Hospital, Puerto Montt Hospital, San Borja Arriarán Hospital, San Felipe Hospital, San José Hospital and San Juan de Dios Hospital new.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 757 "Ancho" => 991 "Tamanyo" => 98627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ocular fundus photograph showing posterior aggressive retinopathy with plus disease in 4 quadrants.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ROP type 1 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Threshold ROP (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BH-ROP (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Females, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gestational age (weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (24–30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (23–29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (23–26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight at birth (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">830 (450–1.350) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">773 (608–1.065) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">772 (660–960) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Teller test (cycles/cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.85 (0.32–6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (1.6–6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3 (0.64–3.20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sphere \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−2 (+1.5 to −10.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−4.5 (0 to −12.50)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−5.5 (−2 to −14)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cylinder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0 to −4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.5 (0 to −4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0 to −4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1523984.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Statistically significant difference when comparing with ROP type 1 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of demographic data, median GA, median weight at birth and refractive results for the various ROP types.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bevacizumab (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Laser (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>49) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Females, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gestational age (weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.2 (23 to 28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.2 (23 to 30)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight at birth (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">730 (536 to 960) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">860 (450 to 1350)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Teller test (cycles/cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.2 (0.64 to 6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.2 (0.32 to 6.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sphere \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−2.21 (+1.5 to −14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−3.46 (0 to −12.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cylinder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−1.5 (0 to −4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0 to −4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1523985.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Statistically significant difference when comparing with bevacizumab group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison between patients treated with laser and with bevacizumab.</p>" ] ] ] 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