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Evolution of retinal detachment in posterior retinopathy of prematurity: impact on treatment approach
Anand Vinekar1, Michael T Trese, Antonio Capone
1Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Insights
Aggressive posterior retinopathy of prematurity (APROP) can lead to retinal detachment even after laser treatment. Further laser intervention may be needed for avascular retina as flat neovascularization regresses.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Retinal Diseases
Background:
- Aggressive posterior retinopathy of prematurity (APROP) is a severe form of retinopathy of prematurity.
- Retinal detachment is a serious complication that can lead to vision loss.
Purpose of the Study:
- To investigate the clinical course of retinal detachment in infants with APROP.
- To understand the outcomes of laser ablation in eyes with APROP.
Main Methods:
- Prospective, multicenter, masked clinical trial.
- Serial digital photographic imaging of five infants in the PHOTO-ROP Study.
- Analysis of eyes that developed bilateral retinal detachment.
Main Results:
- All five infants developed retinal detachment in both eyes despite peripheral laser ablation.
- APROP with flat neovascularization was present at treatment initiation.
- Plus disease initially resolved but recurred, leading to retinal detachment around 41 weeks postconceptually.
- Preretinal vitreous organization was observed in all affected eyes.
Conclusions:
- Eyes with APROP may have an atypical disease course post-laser ablation.
- Poor outcomes are possible even when plus disease temporarily resolves.
- Additional laser treatment to avascular retina may be required after regression of neovascularization.
- Absence of fibrosis does not guarantee a reduced risk of retinal detachment.
Purpose:
To provide insight into the course of retinal detachment in eyes with aggressive posterior retinopathy of prematurity (APROP).
Design:
Prospective, multicenter, masked clinical trial.
Methods:
Multicenter trial based on serial digital photographic imaging detailing five infants (in the Photographic Screening for Retinopathy of Prematurity [PHOTO-ROP] Study) in whom bilateral retinal detachment developed during the course of the study.
Results:
Retinal detachment developed in both eyes (n=10) of all five infants despite peripheral retinal laser ablation. The mean birth weight was 651.4+/-45.30 g (range, 601 to 718 g), and the mean gestation was 26.75+/-0.96 weeks (range, 24 to 26 weeks). APROP (flat neovascularization) was present in all eyes at the time of treatment. Laser treatment was performed at a mean postconceptual age of 37.25+/-1.8 weeks (range, 35 to 39.57 weeks). Plus disease resolved initially and then recurred (mean, 9.5 days) with progression to retinal detachment; the mean postconceptual age at the time of retinal detachment was 41.42+/-3.6 weeks (range, 36 to 47.29 weeks). Untreated avascular retina became visible with regression of flat preretinal neovascularization. All 10 eyes showed preretinal vitreous organization (most prominent nasally) along the retinal surface without significant transvitreal components.
Conclusions:
Eyes with APROP may follow an atypical course after laser ablation. Such eyes may still fare poorly, even when plus disease wanes. Additional laser to avascular retina may be necessary after the overlying flat stage 3 neovascularization regresses. The absence of obvious fibrosis at the time of laser should provide no reassurance as to reduced probability of progression to retinal detachment.
