The outcomes of screening retinopathy in risky preterms Review

Öz

As ROP causes serious complications and significiant morbidity in preterms it is mandatory to be screened In this study our aim is determining the incidence of ROP in preterms who were followed in our prematurity unit and search the relationship between risk factors and the disease All patients who were smaller than 1500 gr and 32 gestational weeks GW and prematures small for gestational age SGA who had perinatal asphyxia and received oxygen for more than 48 hours and who had a ventilation with CPAP were accepted to this study The patients were referred to a retina unit in the 4 8 weeks of postnatal life and evaluated by the same ophtalmologist by pediatric speculum pediatric scleral depresser and 20 dioptry lens with indirect ophtalmoscopy Topical anesthesia was used during the examination ROP cases were called for control in 1 4 weeks and examinations were terminated when the progression of retina completed One hundered seventy prematures were screened in 34 weeks According to the birth weight distribution of the cases was as follows; 25 cases were smaller than 1000 gr 15 48 cases were 1001 1250 gr 28 67 cases were 1251 1500 gr 39 4 and 30 were more than 1500 gr 17 6 According to the GW; 40 cases were 24 28 GW 23 5 86 cases 29 32 GW 56 and 44cases were kaolder than 32 GW 26 Seventy two percent of preterms were screened in 4 8 weeks 25 after 8 weeks and 3 in the third week of life When the risk factors were evaluated; 82 of preterms were found to be less than 1500 gr 75 smaller than 32 GW; 32 5 were ventilated with CPAP and 7 6 were treated because of septicemia Among 170 patients 15 were grade I 11 were grade II 3 were grade III and 1 was grade IV Total incidence is 17 6 and proportion of the cases which were more than grade II is 2 4 A spontaneous regression was observed in one patient with grade III ROP while one needed criotherapy and one laser threpy One patient who had grade IV ROP in one eye was not appropriate for surgery because of late application Because most of our patients had received second level care the proportion of the cases who had ROP more than grade II was found to be low We consider that ROP must be screened as it is an important problem of especially VLBW preterms and the screening rate must be increased Key words: Retinopathy of prematurity screening very low birth weight

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Riskli prematürelerde retinopati taraması ve sonuçları Derleme

Öz

Riskli prematürelerin önemli sorunlarından olan prematüre retinopatisi ROP ciddi komplikasyonlara neden olduğundan taranması zorunlu bir hastalıktır Bu çalışmada amacımız ünitemizde izlenen riskli prematürelerin ROP sıklığını belirlemek ve risk faktörleri ile hastalık arasındaki ilişkiyi araştırmaktır İzlenen lt;1500 gr lt;32 gebelik haftası GH tüm prematüreler ile perinatal asfiksisi olan 48 saatten fazla oksijen alan CPAP ile ventilasyon desteği uygulanan SGA Small for gestational age prematüreler çalışma kapsamına alındı Postnatal 4 8 haftada göz kliniğine gönderilen olgular aynı hekim tarafından pediatrik spekulum pediatrik skleral depresör ve 20 dioptrilik lens kullanılarak indirekt oftalmoskopi ile değerlendirildi Muayenede topikal anestezi kullanıldı Prematüre retinopatisi saptanan olgular 1 4 hafta arasında kontrole çağrıldı Retina gelişimi tamamlanana kadar kontrollere devam edildi Otuzdört ayda 170 prematüre tarandı Doğum ağırlığına göre olguların dağılımı:1000 gr’dan küçük 25 15 ; 1001 1250 gr 48 28 ; 1251 1500 gr 67 39 4 ;1500 gr’dan büyük 30 17 6 olarak bulundu Gebelik haftasına GH göre dağılımı ise şöyle idi: 24 28 GH 40 23 5 ; 29 32 GH 86 56 ; gt;32 GH 44 26 Prematürelerin 72’i 4 8 haftada 25’i 8 haftadan sonra 3’ü ise 3 haftada değerlendirildi Risk faktörlerine göre olguların 82’i 1500 gr’dan küçük 75’i 32 GH’dan küçük 32 5’i CPAP ile solunum desteği almış 7 6’ı sepsis tedavisi görmüş prematürelerdi Yüzyetmiş hastanın 15’i Grade I 11’i Grade II 3’ü Grade III 1’i Grade IV ROP idi Toplam sıklık 17 6 Grade II’den büyük hasta oranı ise 2 4 idi Olgularımızdan Grade III 1 olguda spontan regresyon görülürken birer olguya kriyoterapi ve lazer uygulandı Grade IV ve tek gözde lezyonu olan hastaya geç dönemde gelmesi nedeni ile cerrahi uygulanmadı Kliniğimizin Grade II’den büyük ROP oranı hastalarımızın çoğunun II düzey bakım gören prematüreler olması nedeniyle düşük bulunmuştur Çok düşük doğum ağırlıklı prematürelerin önemli bir sorunu olan ROP mutlaka taranması gereken bir hastalık olup tarama oranının yükseltilmesi gerektiği kanaatindeyiz Anahtar Kelimeler: Prematüre retinopatisi tarama çok düşük doğum ağırlığı

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