Michael F Chiang1, Graham E Quinn2, Alistair R Fielder3, Susan R Ostmo4, R V Paul Chan5, Audina Berrocal6, Gil Binenbaum2, Michael Blair7, J Peter Campbell4, Antonio Capone8, Yi Chen9, Shuan Dai10, Anna Ells11, Brian W Fleck12, William V Good13, M Elizabeth Hartnett14, Gerd Holmstrom15, Shunji Kusaka16, Andrés Kychenthal17, Domenico Lepore18, Birgit Lorenz19, Maria Ana Martinez-Castellanos20, Şengül Özdek21, Dupe Ademola-Popoola22, James D Reynolds23, Parag K Shah24, Michael Shapiro25, Andreas Stahl26, Cynthia Toth27, Anand Vinekar28, Linda Visser29, David K Wallace30, Wei-Chi Wu31, Peiquan Zhao32, Andrea Zin33. 1. National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: michael.chiang@nih.gov. 2. Division of Ophthalmology, Children's Hospital of Philadelphia, Scheie Eye Institute, Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Optometry and Visual Science, University of London, London, United Kingdom. 4. Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. 5. Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois. 6. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. 7. Retina Consultants, Ltd., Des Plaines, Illinois; Department of Ophthalmology, University of Chicago, Chicago, Illinois. 8. Associated Retinal Consultants, PC, Royal Oak, Michigan, and Department of Ophthalmology, Oakland University, William Beaumont Hospital School of Medicine, Auburn Hills, Michigan. 9. Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China. 10. Ophthalmology Department, Queensland Children's Hospital, Brisbane, Australia. 11. Calgary Retina Consultants, Calgary, Canada. 12. Department of Ophthalmology, University of Edinburgh, Edinburgh, United Kingdom. 13. Smith-Kettlewell Eye Research Institute, San Francisco, California. 14. Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. 15. Department Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden. 16. Department of Ophthalmology, Kindai University, Osakasayama, Japan. 17. Department of Ophthalmology, KYDOFT Foundation, Santiago, Chile. 18. A. Gemelli Foundation IRCSS, Department of Ageing and Neuroscience, Catholic University of the Sacred Heart, Rome, Italy. 19. Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany; Department of Ophthalmology, Universitaetsklinikum Bonn, Bonn, Germany. 20. Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico. 21. Department of Ophthalmology, School of Medicine, Gazi University, Ankara, Turkey. 22. Department of Ophthalmology, University of Ilorin, Ilorin, Nigeria. 23. Ross Eye Institute, Department of Ophthalmology, University at Buffalo, Buffalo, New York. 24. Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India. 25. Retina Consultants, Ltd., Des Plaines, Illinois. 26. Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany. 27. Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina. 28. Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India. 29. Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa. 30. Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana. 31. Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, and Chang Gung University, College of Medicine, Taoyuan, Taiwan. 32. Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 33. Clinical Research Unit, Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil.
Abstract
PURPOSE: The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system. DESIGN: Review of evidence-based literature, along with expert consensus opinion. PARTICIPANTS: International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men. METHODS: The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification. MAIN OUTCOME MEASURES: Consensus statement. RESULTS: The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae. CONCLUSIONS: These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care. Published by Elsevier Inc.
PURPOSE: The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system. DESIGN: Review of evidence-based literature, along with expert consensus opinion. PARTICIPANTS: International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men. METHODS: The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification. MAIN OUTCOME MEASURES: Consensus statement. RESULTS: The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae. CONCLUSIONS: These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care. Published by Elsevier Inc.
Entities:
Keywords:
Neonatology; Pediatric ophthalmology; Prematurity; Retina; Retinopathy of prematurity
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