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Aggressive posterior retinopathy of prematurity: risk factors for retinal detachment despite confluent laser
Gaurav Sanghi1, Mangat R Dogra, Deeksha Katoch
1Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Infants born before 29.5 weeks gestation with aggressive posterior retinopathy of prematurity (ROP) face higher risks of retinal detachment after laser treatment. Preretinal hemorrhages and new fibrovascular traction also predict poor outcomes.
Area of Science:
- Ophthalmology
- Neonatal Care
- Retinal Diseases
Background:
- Aggressive posterior retinopathy of prematurity (ROP) is a severe condition requiring timely intervention.
- Laser photocoagulation is a standard treatment, but risk factors for treatment failure leading to retinal detachment require further analysis.
Purpose of the Study:
- To identify and analyze risk factors associated with retinal detachment in eyes diagnosed with aggressive posterior retinopathy of prematurity (ROP) following laser photocoagulation treatment.
Main Methods:
- Retrospective analysis of infants treated for aggressive posterior ROP between 2006 and 2010.
- Comparison of eyes with favorable outcomes versus those progressing to retinal detachment.
- Statistical analysis using univariate and multivariate logistic regression to identify predictors of retinal detachment.
Main Results:
- Nineteen percent of treated eyes progressed to retinal detachment.
- Significant predictors included gestational age < 29.5 weeks, preretinal hemorrhages, and need for repeat laser treatment.
- Posterior zone 1 disease and extensive fibrovascular proliferation (>3 clock hours) were also associated with detachment.
Conclusions:
- Gestational age, posterior zone 1 disease, and preretinal hemorrhages are key risk factors for retinal detachment in aggressive posterior ROP.
- New-onset fibrovascular traction post-treatment is significantly associated with the development of retinal detachment.
Purpose:
To analyze risk factors for retinal detachment in eyes with aggressive posterior retinopathy of prematurity (ROP) treated with confluent laser photocoagulation.
Design:
Retrospective, consecutive, interventional case series.
Methods:
Infants undergoing laser treatment for aggressive posterior ROP from January 2006 through June 2010 participated. Eyes with retinal detachment (stage 4A, 4B, and 5) at presentation and those lost to follow-up after treatments were excluded. We defined 2 groups based on outcome after confluent laser photocoagulation: retinal detachment or favorable outcome. Two groups were compared for various factors, which included birth weight, gestational age, postconceptional age at laser treatment, zone of disease, preretinal hemorrhage, pre-existing fibrovascular proliferation, tunica vasculosa lentis, laser spots used for primary treatment, need for repeat laser treatment, and new-onset fibrovascular proliferation after laser treatment. Data were analyzed using univariate and multivariate logistic regression analysis.
Results:
One hundred nineteen eyes of 61 infants underwent laser treatment for aggressive posterior ROP. Ten (8.4%) eyes were excluded and 109 eyes (91.6%) were included. Nineteen (17.4%) of 109 eyes progressed to retinal detachment after laser treatment. On univariate analysis, multiple factors were associated with retinal detachment. Of these, all eyes with posterior zone 1 disease and all eyes demonstrating extensive fibrovascular proliferation (> 3 clock hours) after laser treatment progressed to retinal detachment. On multivariate logistic regression analysis, the most significant predictors of retinal detachment were gestational age of less than 29.5 weeks (P = .006), hemorrhages (P = .003), need for repeat laser treatment (P = .006), and new-onset limited fibrovascular traction (< 3 clock hours) after laser treatment (P = .042).
Conclusions:
A gestational age of less than 29.5 weeks, posterior zone 1 disease, and preretinal hemorrhages before laser treatment are the most significant risk factors for retinal detachment in aggressive posterior ROP. Of the events occurring after laser treatment, new-onset fibrovascular traction is associated significantly with development of retinal detachment.
