International Classification of Retinopathy of Prematurity, 3rd edition

By M. Chiang, G. Quinn, A. R. Fielder, S. Ostmo, R. Chan, A. Berrocal, G. Binenbaum, M. Blair, J. Campbell, A. Capone and 25 more. Ophthalmology (Rochester, Minn.), 2021

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Objective: The International Classification of Retinopathy of Prematurity (ICROP) 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 paper presents a third revision (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 post-treatment compared to ablative therapies, and (4) recognition that patterns of ROP in some regions of the world do not neatly fit into the current classification system. Design: Review of evidence-based literature, along with expert consensus opinion. Subjects, Participants, and/or Controls: International ROP expert committee assembled in March 2019 (17 countries represented; 14 pediatric ophthalmologists, 20 retinal specialists; 12 females, 22 males). Methods: The committee was initially broken into three subcommittees (acute phase, regression/reactivation, 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, two in-person multi-day meetings, and an online message board to develop consensus on classification. Results: 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 ICROP3 include refined classification metrics (e.g. “posterior zone II”, “notch” to describe incursion of disease into a more posterior zone, sub-categorization of stage 5, recognition that there is a continuous spectrum of vascular abnormality from normal to plus disease). They also include definition of aggressive ROP (A-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 for the first time 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 in the future.

Subfields: Pediatrics, Perinatology and Child Health, Pulmonary and Respiratory Medicine, Radiology, Nuclear Medicine and Imaging

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