Presumed transient reactive astrocytic hyperplasia in immature retina

To describe the appearance and clinical course of small, white, endophytic calcific, peripheral lesions in developing retina of premature infants.

Retrospective review of all patients evaluated for retinopathy of prematurity (ROP) at a level I neonatal intensive care unit (NICU) in San Jose, CA, between January 1, 2003, and December 31, 2004. Patients were examined either in the NICU or the affiliated outpatient clinic. Clinical examination consisted of dilated fundus examination with 360 degree scleral depression. Lesions were identified if they were white, calcific, peripheral, and transient. Ancillary testing and examination of family members was performed as indicated.

A total of 302 unique patients were screened for ROP. Ten lesions were identified in seven eyes. Three eyes had two lesions each. All lesions were unilateral. The size of the lesions was estimated to range between 500 and 700 microm. All lesions were located anterior to the vascularized retina, had minimal elevation on scleral depression, and demonstrated a predilection for the nasal and temporal raphe. Ultrasound findings demonstrated an elevated, hyperechoic mass with orbital shadowing. Computed tomography and magnetic resonance imaging tests did not demonstrate the lesions. Lesions involute slowly over a period of 6 months. There were no systemic findings or familial dispositions.

Immature retina in premature infants may predispose to the formation of transient reactive astrocytic hyperplasia. Development of mature retinal vascularization and spontaneous resolution of lesions should alleviate concerns regarding a more malignant diagnosis.