Current Practices in Treating Retinopathy of Prematurity in the Philippines
Kristine G. Pormida, MD, DPBO, Jocelyn L. Sy, MD, DPBO, Jubaida M. Aquino, MD, DPBO
Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
Correspondence: Kristine G. Pormida, MD, DPBO
Office Address: Department of Health Eye Center, East Avenue Medical Center, East Avenue, Diliman, Quezon City, Metro Manila, Philippines
Office Contact Number: +639177233607
Email Address: pormidakristine@gmail.com
Disclosures: The authors report no conflict of interest.
ABSTRACT
Objective: To identify the current practices of ophthalmology subspecialists involved in the treatment of retinopathy of prematurity (ROP) in the Philippines.
Methods: A survey was conducted among members of the Vitreo-Retina Society of the Philippines (VRSP) and the Philippine Society of Pediatric Ophthalmology and Strabismus (PSPOS) who treat ROP. The electronic questionnaire covered treatment preferences and factors influencing these preferences regarding the use of anti-vascular endothelial growth factor (anti-VEGF), laser indirect ophthalmoscopy (LIO), cryotherapy, and surgical interventions. Questions about referral system and ROP recurrences encountered by the respondents were included.
Results: A total of 73 out of 86 (85.00% response rate) possible respondents were included in the study, majority (80.82%) of whom were retina subspecialists. The initial treatment preference for type 1 ROP was laser indirect ophthalmoscopy (43.84%), while anti-VEGF injection (67.12%) was preferred for aggressive posterior ROP (APROP). Among the available anti-VEGF agents, bevacizumab was the most favored (68.11%). Most ROP consultations (59.79%) occurred through referrals, primarily from pediatricians or neonatologists (91.78%). Subspecialists reported encountering more recurrences with anti-VEGF injections compared to LIO. LIO was the most preferred treatment after failed initial anti-VEGF therapy, with most recurrences occurring in patients older than 50 weeks post-conceptual age.
Conclusion: This study underscored the diverse treatment practices for ROP in the Philippines, influenced by factors such as variable access to equipment or drugs, clinician experience with specific treatments, and ocular factors such as faster regression of neovascularization. LIO was preferred as the initial therapy for Type 1 ROP and for managing recurrences, while anti-VEGF injections were favored for APROP and as an alternative treatment for Type 1 ROP. Given the absence of an established standard for treating recurrent ROP cases, long-term monitoring is necessary to facilitate timely interventions and prevent blindness.
Keywords: retinopathy of prematurity, aggressive posterior retinopathy of prematurity, anti-VEGF injection, laser indirect ophthalmoscopy, bevacizumab