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Binocularity outcomes following treatment for retinopathy of prematurity

Published:November 05, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.10.007

      Abstract

      Objective

      Retinopathy of prematurity (ROP) is a leading cause of childhood visual impairment. Treatment options for severe ROP include laser and/or anti–vascular endothelial growth factor (anti-VEGF) injections. Previous studies have compared the 2 treatments for functional outcomes including visual acuity, amblyopia, and strabismus. The purpose of this study was to evaluate the influence of treatment on binocularity.

      Methods

      In this masked, cross-sectional study, binocularity was measured using Bagolini lenses and the Frisby stereotest in children aged 3–8 years with a history of ROP treatment in 2 Canadian centres. Events associated with disruption of binocularity including amblyopia, anisometropia, and strabismus, were recorded and analyzed as secondary outcomes.

      Results

      A total of 42 children were recruited: 19 were treated with laser and 23 with an anti-VEGF agent. The mean age at the time of assessment in the laser group was 81.2 (6.8 years) ± 16.2 months versus 63 (5.25 years) ± 15.7 months in the anti-VEGF group (p < 0.001). No statistically significant difference in rates of binocularity was detected (68% laser vs 82% anti-VEGF, p = 0.27). Laser-treated participants experienced a greater number of cumulative insults to binocularity (p = 0.01).

      Conclusions

      Patients with a history of ROP treated with laser or anti-VEGF agents require long-term follow-up to address binocularity-disrupting factors. Although we did not detect a difference in rates and level of binocularity between treatment groups, we did find an increased rate of cumulative binocularity disrupting events in the laser-treated group.

      Objectif

      La rétinopathie du prématuré (RDP) est une cause importante de déficience visuelle chez l'enfant. Parmi les options thérapeutiques de la RDP grave, citons le traitement au laser et/ou les injections d'anti-VEGF (facteur de croissance endothélial vasculaire). Des études antérieures ont comparé les 2 traitements quant aux résultats fonctionnels, notamment l'acuité visuelle, l'amblyopie et le strabisme. La présente étude vise plutôt à évaluer l'effet du traitement sur la vision binoculaire.

      Méthodes

      Dans le cadre de cette étude transversale réalisée à l'insu, on a mesuré la vision binoculaire au moyen des verres de Bagolini et du stéréotest de Frisby chez des enfants de 3 à 8 ans ayant des antécédents de traitement en raison d'une RDP dans 2 centres canadiens. Les phénomènes associés à une perturbation de la vision binoculaire, dont l'amblyopie, l'anisométropie et le strabisme, ont été notés et analysés à titre de paramètres secondaires.

      Résultats

      On a recruté 42 enfants : 19 avaient été traités au laser, tandis que 23 avaient reçu un anti-VEGF. Au moment de l’évaluation, l’âge moyen des sujets du groupe laser était de 81,2 ± 16,2 mois (6,8 ans), comparativement à 63 ± 15,7 mois (5,25 ans) chez ceux du groupe anti-VEGF (p < 0,001). On n'a enregistré aucune différence statistiquement significative quant au taux de vision binoculaire (68 % dans le groupe laser vs 82 % dans le groupe anti-VEGF; p = 0,27). Les sujets qui avaient été traités au laser présentaient un plus grand nombre de phénomènes cumulatifs nuisant à la vision binoculaire (p = 0,01).

      Conclusions

      Les patients qui ont des antécédents de RDP traitée au laser ou par injections d'anti-VEGF doivent faire l'objet d'un suivi à long terme pour assurer la prise en charge des facteurs qui nuisent à la vision binoculaire. Bien que nous n'ayons pas décelé de différence quant au taux ni au degré de vision binoculaire entre les groupes de traitement, nous avons tout de même constaté un taux plus élevé de phénomènes cumulatifs nuisant à la vision binoculaire dans le groupe laser.
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