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• W4200435526 abstract "We appreciate the thoughtful suggestions of the authors. The International Classification of Retinopathy of Prematurity, 3rd Edition (ICROP3), group was an international committee of ophthalmologists from 6 continents who aimed to provide a globally acceptable terminology.1Chiang M.F. Quinn G.E. Fielder A.R. et al.International classification of retinopathy of prematurity, third edition.Ophthalmology. 2021; 128: e51-e68Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar The goal of the committee was to identify key changes that would balance responding to clinical needs and supporting future research studies, while minimizing increases to the complexity of clinical practice. During the committee meetings that led to ICROP3, we considered and discussed each of the suggestions raised by the authors in detail. With regard to the suggestion that there should be a posterior zone I classification, the committee felt that the clinical need to further subdivide zone I did not outweigh the added complexity of doing so. Concerning the suggestion to retain aggressive-posterior retinopathy of prematurity, the committee articulated the rationale for changing the terminology to aggressive retinopathy of prematurity (A-ROP) in the article as follows: “aggressive ROP is increasingly recognized also to occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources.2Shah P.K. Narendran V. Saravanan V.R. et al.Fulminate retinopathy of prematurity - clinical characteristics and laser outcome.Indian J Ophthalmol. 2005; 53: 261-265Crossref PubMed Scopus (24) Google Scholar Therefore, because the key diagnostic features of this phenotype are the tempo of disease and appearance of vascular abnormalities, but not location of disease, the committee recommends use of the new term A-ROP to replace aggressive-posterior retinopathy of prematurity. The hallmark of A-ROP is the rapid development of pathologic neovascularization and severe plus disease without progression being observed through the typical stages of ROP.”1Chiang M.F. Quinn G.E. Fielder A.R. et al.International classification of retinopathy of prematurity, third edition.Ophthalmology. 2021; 128: e51-e68Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar It would be possible for future clinical research studies to add further descriptors to examine the significance of this distinction (e.g., aggressive-posterior ROP as a subclass of A-ROP with a location definition if used). With regard to the suggestion of incorporating “hybrid” disease into ICROP3, the committee wished to avoid additional subdivision where possible. We note that hybrid disease, referring to the overlap of “classical” and “aggressive” ROP, is included within our definition of A-ROP: “extraretinal neovascularization as seen in classic stage 3 disease can also be seen in eyes with A-ROP.”1Chiang M.F. Quinn G.E. Fielder A.R. et al.International classification of retinopathy of prematurity, third edition.Ophthalmology. 2021; 128: e51-e68Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar,3Sanghi G. Dogra M.R. Dogra M. et al.A hybrid form of retinopathy of prematurity.Br J Ophthalmol. 2012; 96: 519-522Crossref PubMed Scopus (20) Google Scholar It is our hope that the changes introduced in ICROP3 will help clinicians provide the best care for premature infants, while also creating a foundation to support future research studies that continue to advance the field. Perhaps some of the issues described by the authors can be part of research studies that may inform future disease classification systems. Re: Chiang et al.: International Classification of Retinopathy of Prematurity, Third Edition (Ophthalmology. 2021;128:e51–e68)OphthalmologyVol. 129Issue 3PreviewIn their article, Chiang et al1 updated the International Classification of Retinopathy of Prematurity (ICROP) to improve objectivity of finding, as well as to encompass clinical variations observed in regression or reactivation of retinopathy of prematurity (ROP), particularly after treatment with anti-vascular endothelial growth factor. The authors have subclassified zone II as anterior and posterior to identify the more serious disease in posterior zone II. However, the standard of care for the disease in both the zones is likely to be laser photocoagulation. Full-Text PDF" @default.
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• W4200435526 doi "https://doi.org/10.1016/j.ophtha.2021.10.020" @default.
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