Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti

Analysis of peripheral vascular changes and incidence of retinal detachment

Connie J. Chen, Ian C. Han, Jing Tian, Beatriz Munoz, Morton F Goldberg

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti (IP) has not previously been documented, to our knowledge. OBJECTIVE: To determine which eyes with IP are at risk for retinal detachment. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of patients with IP who were retrospectively identified at a tertiary care academic center between 1976 and 2013. Fifty eyes of 25 female participants meeting clinical criteria for IP were followed up for at least 6 months. The last year of follow-up was between 1987 and 2014. MAIN OUTCOMES AND MEASURES: Progression of retinopathy or the development of retinal detachment was assessed with fluorescein angiography, clinical examination, or both. RESULTS: The median duration of follow-up was 9.3 years (range, 0.5-22.8 years). Over this period, 11 eyes (22%; 95% CI, 11%-33%) developed retinal detachment. The odds of retinal detachment were increased if there was retinal neovascularization (odds ratio, 11.61; 95% CI, 1.34-100.56; P =.03) or ischemic optic neuropathy (odds ratio, 5.27; 95% CI, 1.61-1723; P =.006) on initial examination. A bimodal distribution of retinal detachments was observed, with most tractional detachments (7 eyes) occurring by age 2.5 years (median, 1.5 years; range, 14 days-7.0 years) and most rhegmatogenous detachments (4 eyes) occurring in adults (median age, 31.5 years; range, 14.0-47.0 years). Three eyes of young patients (14.0 years) developed retinal detachment following prophylactic ablation in 6 eyes. Persistent fetal vasculature appears to occur more commonly in IP (14%; 95% CI, 4%-25%) than in the general population. CONCLUSIONS AND RELEVANCE: All eyes with retinopathy due to IP should be monitored throughout adulthood for the development of retinal complications. During infancy and early childhood, ophthalmoscopic examination should be performed frequently so that prompt treatment can be initiated if there is progressive disease. Because of the nonrandomized nature of this study, the indications for prophylactic ablation and its success rate remain uncertain. Patients with less than 6 months of follow-up were excluded from the analysis, which could have biased this study cohort toward patients with more severe or less severe disease.

Original languageEnglish (US)
Pages (from-to)542-548
Number of pages7
JournalJAMA Ophthalmology
Volume133
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Incontinentia Pigmenti
Retinal Detachment
Blood Vessels
Incidence
Cohort Studies
Odds Ratio
Retinal Neovascularization
Ischemic Optic Neuropathy
Fluorescein Angiography
Tertiary Care Centers
Observational Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)

Cite this

@article{f66ecbacbba141b3b96086e408408e6f,
title = "Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti: Analysis of peripheral vascular changes and incidence of retinal detachment",
abstract = "IMPORTANCE: Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti (IP) has not previously been documented, to our knowledge. OBJECTIVE: To determine which eyes with IP are at risk for retinal detachment. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of patients with IP who were retrospectively identified at a tertiary care academic center between 1976 and 2013. Fifty eyes of 25 female participants meeting clinical criteria for IP were followed up for at least 6 months. The last year of follow-up was between 1987 and 2014. MAIN OUTCOMES AND MEASURES: Progression of retinopathy or the development of retinal detachment was assessed with fluorescein angiography, clinical examination, or both. RESULTS: The median duration of follow-up was 9.3 years (range, 0.5-22.8 years). Over this period, 11 eyes (22{\%}; 95{\%} CI, 11{\%}-33{\%}) developed retinal detachment. The odds of retinal detachment were increased if there was retinal neovascularization (odds ratio, 11.61; 95{\%} CI, 1.34-100.56; P =.03) or ischemic optic neuropathy (odds ratio, 5.27; 95{\%} CI, 1.61-1723; P =.006) on initial examination. A bimodal distribution of retinal detachments was observed, with most tractional detachments (7 eyes) occurring by age 2.5 years (median, 1.5 years; range, 14 days-7.0 years) and most rhegmatogenous detachments (4 eyes) occurring in adults (median age, 31.5 years; range, 14.0-47.0 years). Three eyes of young patients (14.0 years) developed retinal detachment following prophylactic ablation in 6 eyes. Persistent fetal vasculature appears to occur more commonly in IP (14{\%}; 95{\%} CI, 4{\%}-25{\%}) than in the general population. CONCLUSIONS AND RELEVANCE: All eyes with retinopathy due to IP should be monitored throughout adulthood for the development of retinal complications. During infancy and early childhood, ophthalmoscopic examination should be performed frequently so that prompt treatment can be initiated if there is progressive disease. Because of the nonrandomized nature of this study, the indications for prophylactic ablation and its success rate remain uncertain. Patients with less than 6 months of follow-up were excluded from the analysis, which could have biased this study cohort toward patients with more severe or less severe disease.",
author = "Chen, {Connie J.} and Han, {Ian C.} and Jing Tian and Beatriz Munoz and Goldberg, {Morton F}",
year = "2015",
month = "5",
day = "1",
doi = "10.1001/jamaophthalmol.2015.22",
language = "English (US)",
volume = "133",
pages = "542--548",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "5",

}

TY - JOUR

T1 - Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti

T2 - Analysis of peripheral vascular changes and incidence of retinal detachment

AU - Chen, Connie J.

AU - Han, Ian C.

AU - Tian, Jing

AU - Munoz, Beatriz

AU - Goldberg, Morton F

PY - 2015/5/1

Y1 - 2015/5/1

N2 - IMPORTANCE: Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti (IP) has not previously been documented, to our knowledge. OBJECTIVE: To determine which eyes with IP are at risk for retinal detachment. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of patients with IP who were retrospectively identified at a tertiary care academic center between 1976 and 2013. Fifty eyes of 25 female participants meeting clinical criteria for IP were followed up for at least 6 months. The last year of follow-up was between 1987 and 2014. MAIN OUTCOMES AND MEASURES: Progression of retinopathy or the development of retinal detachment was assessed with fluorescein angiography, clinical examination, or both. RESULTS: The median duration of follow-up was 9.3 years (range, 0.5-22.8 years). Over this period, 11 eyes (22%; 95% CI, 11%-33%) developed retinal detachment. The odds of retinal detachment were increased if there was retinal neovascularization (odds ratio, 11.61; 95% CI, 1.34-100.56; P =.03) or ischemic optic neuropathy (odds ratio, 5.27; 95% CI, 1.61-1723; P =.006) on initial examination. A bimodal distribution of retinal detachments was observed, with most tractional detachments (7 eyes) occurring by age 2.5 years (median, 1.5 years; range, 14 days-7.0 years) and most rhegmatogenous detachments (4 eyes) occurring in adults (median age, 31.5 years; range, 14.0-47.0 years). Three eyes of young patients (14.0 years) developed retinal detachment following prophylactic ablation in 6 eyes. Persistent fetal vasculature appears to occur more commonly in IP (14%; 95% CI, 4%-25%) than in the general population. CONCLUSIONS AND RELEVANCE: All eyes with retinopathy due to IP should be monitored throughout adulthood for the development of retinal complications. During infancy and early childhood, ophthalmoscopic examination should be performed frequently so that prompt treatment can be initiated if there is progressive disease. Because of the nonrandomized nature of this study, the indications for prophylactic ablation and its success rate remain uncertain. Patients with less than 6 months of follow-up were excluded from the analysis, which could have biased this study cohort toward patients with more severe or less severe disease.

AB - IMPORTANCE: Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti (IP) has not previously been documented, to our knowledge. OBJECTIVE: To determine which eyes with IP are at risk for retinal detachment. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of patients with IP who were retrospectively identified at a tertiary care academic center between 1976 and 2013. Fifty eyes of 25 female participants meeting clinical criteria for IP were followed up for at least 6 months. The last year of follow-up was between 1987 and 2014. MAIN OUTCOMES AND MEASURES: Progression of retinopathy or the development of retinal detachment was assessed with fluorescein angiography, clinical examination, or both. RESULTS: The median duration of follow-up was 9.3 years (range, 0.5-22.8 years). Over this period, 11 eyes (22%; 95% CI, 11%-33%) developed retinal detachment. The odds of retinal detachment were increased if there was retinal neovascularization (odds ratio, 11.61; 95% CI, 1.34-100.56; P =.03) or ischemic optic neuropathy (odds ratio, 5.27; 95% CI, 1.61-1723; P =.006) on initial examination. A bimodal distribution of retinal detachments was observed, with most tractional detachments (7 eyes) occurring by age 2.5 years (median, 1.5 years; range, 14 days-7.0 years) and most rhegmatogenous detachments (4 eyes) occurring in adults (median age, 31.5 years; range, 14.0-47.0 years). Three eyes of young patients (14.0 years) developed retinal detachment following prophylactic ablation in 6 eyes. Persistent fetal vasculature appears to occur more commonly in IP (14%; 95% CI, 4%-25%) than in the general population. CONCLUSIONS AND RELEVANCE: All eyes with retinopathy due to IP should be monitored throughout adulthood for the development of retinal complications. During infancy and early childhood, ophthalmoscopic examination should be performed frequently so that prompt treatment can be initiated if there is progressive disease. Because of the nonrandomized nature of this study, the indications for prophylactic ablation and its success rate remain uncertain. Patients with less than 6 months of follow-up were excluded from the analysis, which could have biased this study cohort toward patients with more severe or less severe disease.

UR - http://www.scopus.com/inward/record.url?scp=84929666596&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929666596&partnerID=8YFLogxK

U2 - 10.1001/jamaophthalmol.2015.22

DO - 10.1001/jamaophthalmol.2015.22

M3 - Article

VL - 133

SP - 542

EP - 548

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 5

ER -