ROP (retinopathy of prematurity) is an eye disease that affects premature babies. It is one of the most common causes of severe visual impairment and blindness in children worldwide.
Photo Credit: Tara Raye
Scientific Frontline: "At a Glance" Summary: Cortisone Eye Drops for Retinopathy of Prematurity
- Main Discovery: The administration of cortisone eye drops, specifically dexamethasone, prevents the progression of severe retinopathy of prematurity in premature infants, often eliminating the need for invasive surgical procedures.
- Methodology: Researchers conducted a registry-based difference-in-differences study using data from the Swedish national quality register for retinopathy of prematurity. They compared outcomes for 2,017 infants born before week 30 of pregnancy, evaluating a region that integrated cortisone drops against three control centers utilizing standard care across two distinct time periods.
- Key Data: Following the introduction of cortisone eye drops in Sweden's Southern Healthcare Region, the necessity for conventional surgical treatment under anesthesia dropped from 72 percent to 13 percent. In contrast, 56 percent of infants at the control hospitals still required conventional surgical intervention during the same period.
- Significance: This therapeutic approach revolutionizes the management of a leading cause of childhood blindness by offering a non-invasive alternative that spares vulnerable premature infants from the significant risks associated with general anesthesia, destructive laser therapy, and ocular injections.
- Future Application: Subsequent clinical research will investigate the long-term developmental effects of the eye drops on systemic and ocular growth, while aiming to identify the physiological factors influencing infants who still require conventional interventions.
- Branch of Science: Ophthalmology, Neonatology, and Pediatrics.
- Additional Detail: The therapeutic benefit of the treatment was discovered incidentally when cortisone drops were initially administered pre-operatively strictly to reduce severe eye inflammation, revealing an unexpected regression of the underlying vascular disease before surgery took place.
Lotta Gränse, ophthalmologist and researcher Lund University and Skåne University Hospital has demonstrated that eye drops containing cortisone can prevent the development of the very serious eye disease ROP in infants. This has revolutionized treatment and means that most children in Sweden’s Southern Healthcare Region with severe ROP do not need conventional treatment under anesthesia to avoid serious visual impairment or blindness. The study has been published in the highly ranked journal Ophthalmology.
ROP (retinopathy of prematurity) is one of the most common causes of severe visual impairment and blindness in children worldwide. Because the blood vessels in the retina are not fully developed, changes in oxygen levels after birth can disrupt normal vascular growth, which may lead to abnormal blood vessels, bleeding, scarring, retinal detachment and, in severe cases, blindness. The conventional treatment is laser therapy on the retina or administering injections of a vascular inhibitor into the eye. Both treatments entail various risks and require anesthesia, which should preferably be avoided for premature babies.
Development of diagnostics and treatment for severe ROP
Lotta Gränse is a docent and project manager for the Retinopathy of Prematurity research team at Lund University and senior ophthalmology consultant at Skåne University Hospital. At Skåne University Hospital, she has been responsible for ROP activities since 2012 and is a unit representative for national specialized medical care relating to certain types of ROP. She is responsible for the screening of premature babies, assessing screening images received from other clinics, and determining if and when treatment under anesthesia is required. Since 2016, she has also been carrying out treatment.
It was absolutely fantastic to see how babies who previously used to get worse and undergo destructive laser surgery, now, with usually only one drop of cortisone a day, sailed past that treatment and healed. It seemed inconceivable that no one had thought of introducing cortisone drops before.
“Over the past ten years, the diagnosis of ROP in the Southern Healthcare Region has been improved by using digital wide-angle photography. The technique has made it possible for us to compare images and follow the course of the disease in a way that was not possible previously,” says Lotta Gränse.
In severe ROP, the eye is very inflamed, and it is difficult for the pupil to dilate, but it is important to have a large pupil for the laser therapy to be as effective as possible. To facilitate treatment, Lotta Gränse began administering a dose of cortisone drops (dexamethasone) a few days before the operation. This dose was the same as recommended in international guidelines for post-operative treatment. She then observed that eye inflammation had subsided and when she compared the images before and during treatment, she could also see that the ROP disease had decreased. In one case, the child could even avoid laser therapy altogether.
“This sparked the idea of starting to administer a lower dose of cortisone drops at an earlier stage before the disease had progressed too far. It was absolutely fantastic to see how babies who previously used to get worse and undergo destructive laser surgery, now, with usually only one drop cortisone a day, sailed past that treatment and healed. It seemed inconceivable that no one had thought of introducing cortisone drops before.”
According to Lotta Gränse, the connection may have gone unnoticed because different professional groups work in separate clinical pathways: pediatric ophthalmologists perform the screening, while retinal surgeons handle the treatment. Previously, there were also no images available during screening and treatment, which made it difficult to get an overview of the disease.
Far fewer children required treatment
Lotta Gränse first published a report on her findings from Skåne University Hospital, but in order to provide greater scientific evidence for the treatment, a national collaborative project was initiated. Lotta Gränse and her research team, along with the neonatal clinic and the Department of Statistics and Epidemiology at Skåne University Hospital, compared the results from the Southern Healthcare Region with three large screening centers in Sweden. The project included a total of 2,017 babies born before week 30 of the pregnancy who were screened for ROP during the periods 2015-2018 and 2020-2021, before and after the introduction of dexamethasone eyedrops in the Southern Healthcare Region when diagnosis of severe ROP.
“Using data from the national quality register for ROP, SWEDROP, we compared the conventional treatment frequency of severe ROP under anesthesia at the three screening centers with the Southern Healthcare Region.”
Between 2015 and 2018, 72 percent (23 out of 32) of babies with severe ROP required conventional treatment under anesthetic in the Southern Healthcare Region. At the three other hospitals, the corresponding figure was 47 percent (82 out of 175).
In 2020-2021, cortisone drops began to be administered in the Southern Healthcare Region. This led to a clear reduction in the need for conventional treatment with only 13 percent (4 out of 32) of babies with severe ROP requiring conventional treatment. The three other hospitals continued with unchanged standard treatment and therefore serve as a control group, where 56 percent (32 out of 57) of the babies received conventional treatment.
Further research on long-term effects
Now Lotta Gränse wants to continue her research to investigate the factors that play a role for babies who still need conventional treatment, and to study the effects of the drops in long-term follow-ups on the development of the eye and the child as a whole.
“According to international guidelines, the ROP disease is currently monitored until it becomes so severe that it must be treated with destructive or invasive treatment under anesthesia. This new strategy, using low-dose cortisone eye drops, is an active treatment to prevent this. It makes a huge difference for the children affected and their families, but also in socio-economic terms. Cortisone drops are inexpensive, whereas surgery is very resource intensive.”
Funding: Swedish state under the USV-grants 2024-2027, The Foundation for Visually Impaired in Former Malmöhus County, The Crown Princess Margareta Foundation, Ögonfonden (the Eyefoundation)
Published in journal: Ophthalmology
Title: Treating Retinopathy of Prematurity with Dexamethasone Eye Drops
Authors: Lotta A.K.C. Gränse, Hanna Maria V. Öhnell, Gerd Holmström, Johanna C. Sundgren, Kristina Teär Fahnehjelm, Agneta Wallin, Eva Larsson, Despoina Tsamadou, Lars J. Björklund, Ann Hellström, Jenny Wallander, Karin Sandgren Hochhard, Sten O.L. Andreasson, Elisabeth R. Olhager, and Jonas Björk
Source/Credit: Lund University | Åsa Hansdotter
Reference Number: med030926_01
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