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Management of avascular peripheral retina in older prematurely born infants
Lawrence Y Ho1, Vincent Ho, Himanshu Aggarwal
1Associated Retinal Consultants, Beaumont Eye Institute, Royal Oak, Michigan, USA. lawrence.y.ho@gmail.com
Insights
This study reviews managing retinopathy of prematurity (ROP) in premature infants with incomplete retinal vascularization after 45 weeks postmenstrual age. Management options include observation or laser ablation for persistent ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Background:
- Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature infants.
- Incomplete retinal vascularization after 45 weeks postmenstrual age (PMA) presents unique management challenges.
- Current guidelines for ROP management primarily focus on earlier stages of the disease.
Purpose of the Study:
- To describe the clinical presentation and management strategies for premature infants with ROP and incomplete vascularization beyond 45 weeks PMA.
- To evaluate the outcomes of laser ablation in this specific patient cohort.
- To inform clinical decision-making for late-stage ROP management.
Main Methods:
- Retrospective, noncomparative case series of premature infants treated for ROP after 45 weeks PMA.
- Inclusion criteria: ROP requiring treatment after 45 weeks PMA at a single tertiary referral center.
- Data collected on patient demographics, ROP characteristics, and treatment interventions.
Main Results:
- Nine patients (18 eyes) received laser photocoagulation after 45 weeks PMA.
- Mean gestational age was 26 weeks 2 days; mean birth weight was 792 g.
- Treatment was administered for Type 1 ROP, peripheral neovascularization, or Zone 3 ROP with persistent plus disease.
Conclusions:
- Management of ROP with incomplete vascularization after 45 weeks PMA requires individualized consideration.
- Laser ablation is a viable treatment option for specific indications in this population.
- Close observation may also be considered, warranting further investigation.
Purpose:
To report on the authors' experience with presentation and management of prematurely born infants who do not fully vascularize after 45 weeks of postmenstrual age (PMA).
Methods:
Retrospective, noncomparative, consecutive case series consisting of premature infants with retinopathy of prematurity (ROP) who were treated with laser ablation after 45 weeks of PMA at a single tertiary referral institution.
Results:
A total of 370 premature infants with ROP were treated at this institution from January 1, 2006, to August 1, 2009. Eighteen eyes of 9 patients received laser photocoagulation after 45 weeks of PMA and were included in this series. The mean gestational age for this subgroup was 26 weeks and 2 days, and mean birth weight was 792 g. Type 1 ROP developed in 3 infants after 45 weeks of PMA and received laser treatment, and 6 infants without Type 1 ROP received laser treatment for an avascular peripheral retina, evidence of peripheral neovascularization, and/or ROP in Zone 3 with persistent plus disease.
Conclusion:
This series represents the authors' experience in the management of prematurely born infants with ROP after 45 weeks of PMA. One may consider close observation or laser ablation for the management of infants who have incomplete peripheral retinal vascularization, peripheral neovascularization, and/or ROP in Zone 3 with persistent plus disease.
