Expert consensus on the classification and treatment of retinopathy of prematurity in China (2023 edition)_Chinese Journal of Ocular Fundus Diseases

Authors：

 Fundus Disease Group of Ophthalmological Society of Chinese Medical Association ,  Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association

Corresponding author：

Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Email: dr_lixiaoxin@163.com; Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association, Email: drxuxun@sjtu.edu.cn

Keywords：

Retinopathy of prematurity; Classification of lesions; Treatment; Expert consensus

DOI：

10.3760/cma.j.cn511434-20230815-00346

Video：

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Retinopathy of prematurity (ROP) is a blinding eye disease of neonates. Early screening and regular follow-up can prevent the disease from leading to serious functional impairment. Rop is classified by the World Health Organization as the prevention target of avoidable blindness in neonates. Since the National Health Commission of the People's Republic of China issued "Guidelines for the treatment of oxygen and the prevention and treatment of retinopathy in prematurity" in 2004, the Ophthalmology Group of the Chinese Academy of Ophthalmology has actively promoted the screening and treatment of ROP, and updated "Guidelines for screening retinopathy of prematurity" in China in 2014. After nearly 20 years of hard work, the disease of stage 5 ROP in China has basically disappeared. In order to reasonably grasp the classification criteria of ROP and the indications of drug treatment, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association organize experts in related fields to reach consensus opinions through serious, comprehensive and full discussion, and update the classification of ROP in China and the Chinese translation of new terms with reference to international standard terms. The standard of anti-vascular endothelial growth factor drug treatment indication is also added to provide reference for clinicians in clinical practice.

Citation： Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. Expert consensus on the classification and treatment of retinopathy of prematurity in China (2023 edition). Chinese Journal of Ocular Fundus Diseases, 2023, 39(9): 720-727. doi: 10.3760/cma.j.cn511434-20230815-00346 Copy

1.	黎晓新. 我国早产儿视网膜病变特点和筛查指南[J]. 中华眼底病杂志, 2004, 20(6): 53-55. DOI: 10.3760/j.issn:1005-1015.2004.06.020.Li XX. Characteristics and screening guidelines for retinopathy of prematurity in China[J]. Chin J Ocul Fundus Dis, 2004, 20(6): 53-55. DOI: 10.3760/j.issn:1005-1015.2004.06.020.
2.	中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.Ophthalmology Group, Ophthalmology Society of Chinese Medical Association. Screening guidelines for retinopathy of prematurity in China (2014)[J]. Chin J Ophthalmol, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.
3.	Mintz-Hittner HA, Kennedy KA, Chuang AZ, et al. Efficacy of intravitreal Bevacizumab for stage 3+ retinopathy of prematurity[J]. N Engl J Med, 2011, 364(7): 603-615. DOI: 10.1056/NEJMoa1007374.
4.	Chiang MF, Quinn GE, Fielder AR, et al. International classification of retinopathy of prematurity, third edition[J/OL]. Ophthalmology, 2021, 128(10): e51-e68[2021-07-08]. https://pubmed.ncbi.nlm.nih.gov/34247850/. DOI: 10.1016/j.ophtha.2021.05.031.
5.	An international classification of retinopathy of prematurity. The committee for the classification of retinopathy of prematurity[J]. Arch Ophthalmol, 1984, 102(8): 1130-1134. DOI: 10.1001/archopht.1984.01040030908011.
6.	International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7): 991-999. DOI: 10.1001/archopht.123.7.991.
7.	Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial[J]. Arch Ophthalmol, 2003, 121(12): 1684-1696. DOI: 10.1001/archopht.121.12.1684.
8.	Multicenter trial of cryotherapy for retinopathy of prematurity. Preliminary results. Cryotherapy for retinopathy of Prematurity Cooperative Group[J]. Arch Ophthalmol, 1988, 106(4): 471-479. DOI: 10.1001/archopht.1988.01060130517027.
9.	Quinn GE, Dobson V, Barr CC, et al. Visual acuity of eyes after vitrectomy for retinopathy of prematurity: follow-up at 5 1/2 years. The cryotherapy for retinopathy of Prematurity Cooperative Group[J]. Ophthalmology, 1996, 103(4): 595-600. DOI: 10.1016/s0161-6420(96)30647-7.
10.	Repka MX, Tung B, Good WV, et al. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP)[J]. Arch Ophthalmol, 2006, 124(1): 24-30. DOI: 10.1001/archopht.124.1.24.
11.	Mintz-Hittner HA, Kuffel RJ. Intravitreal injection of Bevacizumab (Avastin) for treatment of stage 3 retinopathy of prematurity in zone Ⅰor posterior zone Ⅱ[J]. Retina, 2008, 28(6): 831-838. DOI: 10.1097/IAE.0b013e318177f934.
12.	Stahl A, Lepore D, Fielder A, et al. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial[J]. Lancet, 2019, 394(10208): 1551-1559. DOI: 10.1016/S0140-6736(19)31344-3.
13.	Marlow N, Stahl A, Lepore D, et al. 2-year outcome of ranibizumab versus laser therapy for the treatment of very low birth weight infants with retinopathy of prematurity (RAINBOW extension study): prespective follow-up of an open label randomized controlled trial[J]. Lancet Child Adolesc Health, 2021, 5(10): 698-707. DOI: 10.1016/S2352-4642(21)00195-4.
14.	程湧, 梁建宏, 黎晓新. 康柏西普玻璃体腔注射治疗急进性后极部早产儿视网膜病变的疗效观察[J]. 中华眼底病杂志, 2017, 33(2): 144-147. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.008.Cheng Y, Liang JH, Li XX. Intravitreal injection of conbercept for aggressive posterior retinopathy of prematurity[J]. Chin J Ocul Fundus Dis, 2017, 33(2): 144-147. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.008.
15.	Cheng Y, Meng Q, Linghu D, et al. A lower dose of intravitreal conbercept effectively treats retinopathy of prematurity[J/OL]. Sci Rep, 2018, 8(1): 10732[2018-07-16]. https://europepmc.org/article/MED/30013230. DOI: 10.1038/s41598-018-28987-6.
16.	Stahl A, Sukgen EA, Wu WC, et al. Effect of intravitreal Aflibercept vs laser photocoagulation on treatment success of retinopathy of prematurity: The FIREFLEYE randomized clinical trial[J]. JAMA, 2022, 328(4): 348-359. DOI: 10.1001/jama.2022.10564.
17.	Bai Y, Nie H, Wei S, et al. Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity[J]. Br J Ophthalmol, 2019, 103(4): 494-498. DOI: 10.1136/bjophthalmol-2017-311662.
18.	Chang E, Josan AS, Purohit R, et al. A network meta-analysis of retreatment rates following bevacizumab, ranibizumab, aflibercept, and laser for retinopathy of prematurity[J]. Ophthalmology, 2022, 129(12): 1389-1401. DOI: 10.1016/j.ophtha.2022.06.042.
19.	Cheng Y, Zhu X, Linghu D, et al. Comparison of the effectiveness of conbercept and Ranibizumab treatment for retinopathy of prematurity[J/OL]. Acta Ophthalmol, 2020, 98(8): e1004-e1008[2020-05-08]. https://pubmed.ncbi.nlm.nih.gov/32385940/. DOI: 10.1111/aos.14460.
20.	Zhang Q, Qi Y, Chen L, et al. The relationship between anti-vascular endothelial growth factor and fibrosis in proliferative retinopathy: clinical and laboratory evidence[J]. Br J Ophthalmol, 2016, 100(10): 1443-1450. DOI: 10.1136/bjophthalmol-2015-308199.
21.	中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Ophthalmology Group, Ophthalmology Society of Chinese Medical Association. Quality control standard of vitreous injection for retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.

1. 黎晓新. 我国早产儿视网膜病变特点和筛查指南[J]. 中华眼底病杂志, 2004, 20(6): 53-55. DOI: 10.3760/j.issn:1005-1015.2004.06.020.Li XX. Characteristics and screening guidelines for retinopathy of prematurity in China[J]. Chin J Ocul Fundus Dis, 2004, 20(6): 53-55. DOI: 10.3760/j.issn:1005-1015.2004.06.020.
2. 中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.Ophthalmology Group, Ophthalmology Society of Chinese Medical Association. Screening guidelines for retinopathy of prematurity in China (2014)[J]. Chin J Ophthalmol, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.
3. Mintz-Hittner HA, Kennedy KA, Chuang AZ, et al. Efficacy of intravitreal Bevacizumab for stage 3+ retinopathy of prematurity[J]. N Engl J Med, 2011, 364(7): 603-615. DOI: 10.1056/NEJMoa1007374.
4. Chiang MF, Quinn GE, Fielder AR, et al. International classification of retinopathy of prematurity, third edition[J/OL]. Ophthalmology, 2021, 128(10): e51-e68[2021-07-08]. https://pubmed.ncbi.nlm.nih.gov/34247850/. DOI: 10.1016/j.ophtha.2021.05.031.
5. An international classification of retinopathy of prematurity. The committee for the classification of retinopathy of prematurity[J]. Arch Ophthalmol, 1984, 102(8): 1130-1134. DOI: 10.1001/archopht.1984.01040030908011.
6. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7): 991-999. DOI: 10.1001/archopht.123.7.991.
7. Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial[J]. Arch Ophthalmol, 2003, 121(12): 1684-1696. DOI: 10.1001/archopht.121.12.1684.
8. Multicenter trial of cryotherapy for retinopathy of prematurity. Preliminary results. Cryotherapy for retinopathy of Prematurity Cooperative Group[J]. Arch Ophthalmol, 1988, 106(4): 471-479. DOI: 10.1001/archopht.1988.01060130517027.
9. Quinn GE, Dobson V, Barr CC, et al. Visual acuity of eyes after vitrectomy for retinopathy of prematurity: follow-up at 5 1/2 years. The cryotherapy for retinopathy of Prematurity Cooperative Group[J]. Ophthalmology, 1996, 103(4): 595-600. DOI: 10.1016/s0161-6420(96)30647-7.
10. Repka MX, Tung B, Good WV, et al. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP)[J]. Arch Ophthalmol, 2006, 124(1): 24-30. DOI: 10.1001/archopht.124.1.24.
11. Mintz-Hittner HA, Kuffel RJ. Intravitreal injection of Bevacizumab (Avastin) for treatment of stage 3 retinopathy of prematurity in zone Ⅰor posterior zone Ⅱ[J]. Retina, 2008, 28(6): 831-838. DOI: 10.1097/IAE.0b013e318177f934.
12. Stahl A, Lepore D, Fielder A, et al. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial[J]. Lancet, 2019, 394(10208): 1551-1559. DOI: 10.1016/S0140-6736(19)31344-3.
13. Marlow N, Stahl A, Lepore D, et al. 2-year outcome of ranibizumab versus laser therapy for the treatment of very low birth weight infants with retinopathy of prematurity (RAINBOW extension study): prespective follow-up of an open label randomized controlled trial[J]. Lancet Child Adolesc Health, 2021, 5(10): 698-707. DOI: 10.1016/S2352-4642(21)00195-4.
14. 程湧, 梁建宏, 黎晓新. 康柏西普玻璃体腔注射治疗急进性后极部早产儿视网膜病变的疗效观察[J]. 中华眼底病杂志, 2017, 33(2): 144-147. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.008.Cheng Y, Liang JH, Li XX. Intravitreal injection of conbercept for aggressive posterior retinopathy of prematurity[J]. Chin J Ocul Fundus Dis, 2017, 33(2): 144-147. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.008.
15. Cheng Y, Meng Q, Linghu D, et al. A lower dose of intravitreal conbercept effectively treats retinopathy of prematurity[J/OL]. Sci Rep, 2018, 8(1): 10732[2018-07-16]. https://europepmc.org/article/MED/30013230. DOI: 10.1038/s41598-018-28987-6.
16. Stahl A, Sukgen EA, Wu WC, et al. Effect of intravitreal Aflibercept vs laser photocoagulation on treatment success of retinopathy of prematurity: The FIREFLEYE randomized clinical trial[J]. JAMA, 2022, 328(4): 348-359. DOI: 10.1001/jama.2022.10564.
17. Bai Y, Nie H, Wei S, et al. Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity[J]. Br J Ophthalmol, 2019, 103(4): 494-498. DOI: 10.1136/bjophthalmol-2017-311662.
18. Chang E, Josan AS, Purohit R, et al. A network meta-analysis of retreatment rates following bevacizumab, ranibizumab, aflibercept, and laser for retinopathy of prematurity[J]. Ophthalmology, 2022, 129(12): 1389-1401. DOI: 10.1016/j.ophtha.2022.06.042.
19. Cheng Y, Zhu X, Linghu D, et al. Comparison of the effectiveness of conbercept and Ranibizumab treatment for retinopathy of prematurity[J/OL]. Acta Ophthalmol, 2020, 98(8): e1004-e1008[2020-05-08]. https://pubmed.ncbi.nlm.nih.gov/32385940/. DOI: 10.1111/aos.14460.
20. Zhang Q, Qi Y, Chen L, et al. The relationship between anti-vascular endothelial growth factor and fibrosis in proliferative retinopathy: clinical and laboratory evidence[J]. Br J Ophthalmol, 2016, 100(10): 1443-1450. DOI: 10.1136/bjophthalmol-2015-308199.
21. 中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Ophthalmology Group, Ophthalmology Society of Chinese Medical Association. Quality control standard of vitreous injection for retinopathy in China[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.

Chinese Journal of Ocular Fundus Diseases

Expert consensus on the classification and treatment of retinopathy of prematurity in China (2023 edition)

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