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Purpose To determine the incidence of retinopathy of prematurity (ROP) over a 2-year period before and after a change in the practice of oxygen supplementation. Design Nonrandomized, retrospective study. Participants All infants in a single Level III neonatal intensive care unit between the years of 2005 and 2007. Methods A prospective database recorded the gestational age, birth weight, stage and zone of ROP, threshold disease, treatment, final outcome and date of examination, maternal and infant demographics, and neonatal intensive care unit course. Year 1 (August 1, 2005 to July 31, 2006) includes a patient cohort who received the standard oxygen supplementation protocol, which has oxygen targets of 95% to 100% saturation. Year 2 (August 1, 2006 to July 31, 2007) includes a patient cohort who has strictly monitored oxygen targets of 34 weeks corrected gestational age limits of 85% to 100% and target 92% to 97% saturation. Main Outcome Measure Incidence of ROP in year 1 before a change in oxygen protocol compared with the incidence of ROP in year 2 after a change in the oxygen protocol. Results A total of 114 children in year 1 and 108 children in year 2 were identified as having been born or transferred to the Fairview Nursery. Ninety-eight infants were examined before and 92 infants were examined after the change in oxygen standards, comprising 190 consecutive patients examined between September 2005 and October 2007. ROP was present in 35% of infants in group 1 before the change in oxygen protocol compared with 13% after the change in oxygen standards ( P = 0.001); stage 3 decreased from 11% to 2% ( P = 0.021); threshold disease decreased from 7% to 1% ( P = 0.066). Stage 0 (immature vessels, no ROP) incidence increased (pre/post-oxygen change 30%/51% stage 0, P = 0.001). There were statistically significant differences in mode of delivery ( P = 0.007), sepsis P = 0.01), and oxygen at discharge ( P = 0.003). Conclusions Lower oxygen targets at early gestational age and higher oxygen targets at older gestational age decrease the severity and incidence of ROP while inducing normal retinal development. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose To compare the anatomic outcomes of lens-sparing vitrectomy (LSV) with those of combined LSV and scleral buckle (SB) in surgical repair of retinopathy of prematurity (ROP) stage 4 retinal detachment. Design Retrospective, interventional, consecutive case series. Methods Twenty-one eyes of 15 patients with stage 4 ROP detachment were enrolled. All patients were selected from consecutive patients with stage 4 ROP detachment treated with LSV alone or combined LSV and SB. Patient characteristics, including gestational age, birth weight, gender, corrected gestational age at time of surgery, surgical procedure, anatomic outcome, ability to fix and follow, and progression of cataract or glaucoma were recorded. Results Twelve of 21 eyes underwent the combined procedure (LSV with SB), and the remaining nine eyes underwent LSV alone. Eighteen (86%) of 21 eyes achieved retinal reattachment overall, with seven (87%) of eight stage 4B detachments repaired in one surgery. Eleven (85%) of 13 stage 4A detachments were repaired in one surgery. Of the patients in whom treatment failed, two were in the LSV with SB group (2/12; 16%) and one was in the LSV alone group (1/9; 11%). Conclusions The data suggest that SB adds little to the success or failure of LSV and therefore is an unnecessary adjunct to LSV for stage 4 ROP.