{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:05:40Z","timestamp":1784696740269,"version":"3.55.0"},"reference-count":18,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T00:00:00Z","timestamp":1640131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aims to assess the prevalence and characteristics of preterm infants with retinopathy of prematurity (ROP) treated outside the recommended guidelines. In this retrospective monocentric cohort, we included all premature children treated in our department for ROP by laser photoablation or anti-VEGF intravitreal injection. The main outcome was treatment of both eyes for ROP less severe than pre-threshold type 1, treated outside ETROP guidelines. A total of 114 children received treatment for ROP in our department, among whom 32 (28.1%) children received treatment for indications outside the ETROP guidelines for both eyes. The indications outside the guidelines were persistent stage 2 or 3 ROP that showed no evidence of regression after 41 weeks of corrected gestational age (11 children; 34.4%), pre-plus stage (11; 34.4%), difficulties in disease staging (7; 21.9%), type 2 ROP with plus disease (2; 6.2%), and treatment due to logistical difficulties (1; 3.1%; hospitalized in neonatal units hundreds of miles away from our department, with no fundus examination possible in the neonatal unit). To resume, in our cohort, 28.1% of children received treatment for ROP less severe than pre-threshold type 1 both eyes. The main indications for off-label treatment were the persistence of active ROP during follow-up and the presence of pre-plus-stage disease. Our data suggest the need to update ROP treatment criteria to reflect real-life practices. Additional studies are required in order to evaluate the long-term benefits and side effects of treatments outside the recommended indications, and to establish revised treatment guidelines.<\/jats:p>","DOI":"10.3390\/jcm11010039","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T02:01:19Z","timestamp":1640224879000},"page":"39","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Treatment outside the Recommended Guidelines for Retinopathy of Prematurity (ROP): Prevalence, Characteristics, and Issues"],"prefix":"10.3390","volume":"11","author":[{"given":"Daniel","family":"Lema\u00eetre","sequence":"first","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"},{"name":"Faculty of Medicine, Sorbonne Universit\u00e9, 75006 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandine","family":"Barjol","sequence":"additional","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-0992","authenticated-orcid":false,"given":"Youssef","family":"Abdelmassih","sequence":"additional","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Farnoux","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, AP-HP, H\u00f4pital Robert Debre, 75019 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles C.","family":"Martin","sequence":"additional","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Metge","sequence":"additional","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5082-230X","authenticated-orcid":false,"given":"Thibaut","family":"Chapron","sequence":"additional","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"},{"name":"Epidemiology and Statistics Research Center\/CRESS, INSERM, INRA, University of Paris, 75004 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges","family":"Caputo","sequence":"additional","affiliation":[{"name":"Pediatric Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1001\/jamapediatrics.2014.3351","article-title":"Survival and morbidity of preterm children born at 22 through 34 weeks\u2019 gestation in France in 2011: Results of the EPIPAGE-2 cohort study","volume":"169","author":"Ancel","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"EXPRESS Group, Fellman, V., Hellstr\u00f6m-Westas, L., Norman, M., Westgren, M., Kallen, K., Lagercrantz, H., Mars\u00e1l, K., Serenius, F., and Wennergren, M. (2009). One-year survival of extremely preterm children after active perinatal care in Sweden. JAMA, 301, 2225\u20132233.","DOI":"10.1001\/jama.2009.771"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Costeloe, K.L., Hennessy, E.M., Haider, S., Stacey, F., Marlow, N., and Draper, E.S. (2012). Short term outcomes after extreme preterm birth in England: Comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ, 345.","DOI":"10.1136\/bmj.e7976"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"International Committee for the Classification of Retinopathy of Prematurity (2005). The international classification of retinopathy of prematurity revisited. Arch. Ophthalmol., 123, 991\u2013999.","DOI":"10.1001\/archopht.123.7.991"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1001\/archopht.123.3.311","article-title":"15-Year Outcomes Following Threshold Retinopathy of Prematurity: Final Results from the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity","volume":"123","author":"Palmer","year":"2005","journal-title":"Arch. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Early Treatment for Retinopathy of Prematurity Cooperative Group, Good, W.V., and Hardy, R.J. (2010). Final Visual Acuity Results in the Early Treatment for Retinopathy of Prematurity Study. Arch. Ophthalmol., 128, 663\u2013671.","DOI":"10.1001\/archophthalmol.2010.72"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/j.ophtha.2021.05.031","article-title":"International Classification of Retinopathy of Prematurity, Third Edition","volume":"128","author":"Chiang","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1056\/NEJMoa1007374","article-title":"Efficacy of intravitreal bevacizumab for stage 3 + retinopathy of prematurity","volume":"364","author":"Kennedy","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/S0140-6736(19)31344-3","article-title":"Ranibizumab versus Laser Therapy for the Treatment of Very Low Birthweight Infants with Retinopathy of Prematurity (RAINBOW): An Open-Label Randomised Controlled Trial","volume":"394","author":"Stahl","year":"2019","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3928\/15428877-20070501-09","article-title":"Intravitreal bevacizumab in aggressive posterior retinopathy of prematurity","volume":"38","author":"Travassos","year":"2007","journal-title":"Ophthalmic Surg. Lasers Imaging Off. J. Int. Soc. Imaging Eye"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajo.2015.12.005","article-title":"Practice patterns in retinopathy of prematurity treatment for disease milder than recommended by guidelines","volume":"163","author":"Gupta","year":"2016","journal-title":"Am. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"332.e1","DOI":"10.1016\/j.jaapos.2019.08.279","article-title":"Treatment of non-type 1 retinopathy of prematurity in the Postnatal Growth and Retinopathy of Prematurity (G-ROP) study","volume":"23","author":"Liu","year":"2019","journal-title":"J. AAPOS"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1007\/s00417-020-04706-8","article-title":"Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines","volume":"258","author":"Rajan","year":"2020","journal-title":"Graefes. Arch. Clin. Exp. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1001\/archophthalmol.2011.63","article-title":"Predictive value of pre-plus disease in retinopathy of prematurity","volume":"129","author":"Wallace","year":"2011","journal-title":"Arch. Ophthalmol."},{"key":"ref_15","first-page":"1","article-title":"Screening for retinopathy of prematurity in very preterm children: The epipage-2 cohort study","volume":"11","author":"Chapron","year":"2021","journal-title":"Neonatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1542\/peds.2014-3526","article-title":"Cognition and brain structure following early childhood surgery with anesthesia","volume":"136","author":"Backeljauw","year":"2015","journal-title":"Pediatrics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1056\/NEJMe1100248","article-title":"Bevacizumab for retinopathy of prematurity","volume":"364","author":"Reynolds","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_18","first-page":"850","article-title":"Proposition for perinatal care at extremely low gestational ages. Workshop \u201cExtremely low gestational ages\u201d SFMP, CNGOF, SFN","volume":"48","author":"Ancel","year":"2020","journal-title":"Gynecol. Obstet. Fertil. Senol"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/39\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:51:28Z","timestamp":1760169088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/39"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,22]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["jcm11010039"],"URL":"https:\/\/doi.org\/10.3390\/jcm11010039","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,22]]}}}