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Adult retinopathy of prematurity: treatment implications, long term sequelae, and management
Emmanuel Chang1,2, Prethy Rao1,2
1Retina and Vitreous of Texas.
Insights
Retinopathy of prematurity (ROP) is now recognized as a lifelong condition. Adult ROP anatomy and its long-term effects require lifelong monitoring for proper management.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Neonatal Care
Background:
- Retinopathy of prematurity (ROP) was traditionally viewed as a neonatal condition.
- A paradigm shift now recognizes ROP as a lifelong disease extending into adulthood.
- Pediatric ophthalmologists and retinal specialists are increasingly managing adult ROP cases.
Purpose of the Study:
- To describe the anatomical characteristics of ROP in adults.
- To discuss the long-term sequelae and management strategies for adult ROP.
- To highlight the evolving understanding of ROP as a chronic condition.
Main Methods:
- Review of current literature on adult ROP.
- Analysis of anatomical changes in eyes treated for neonatal ROP.
- Discussion of late complications and management approaches.
Main Results:
- Neonatal ROP treatments impact both anterior and posterior ocular segments.
- Chronic changes include cataract, secondary glaucoma, and corneal decompensation.
- Persistent avascular retina, lattice-like changes, retinal tears, and detachments are observed in adult ROP, leading to neovascularization and various detachment types.
Conclusions:
- Understanding adult ROP anatomy is crucial for accurate diagnosis and treatment selection.
- Lifelong monitoring is essential for patients with a history of ROP.
- Early identification and management of late ROP sequelae can improve patient outcomes.
Purpose Of Review:
Classically, ROP has been considered a neonatal disease only; however, pediatric ophthalmologists and retinal specialists worldwide are recently facing a new paradigm shift. retinopathy of prematurity (ROP) is now considered a lifelong disease that extends well into adulthood. The purpose of this review is to describe the adult ROP anatomy and discuss the late sequelae and management of this disease.
Recent Findings:
Neonatal ROP treatments affect both anterior and posterior segment anatomy. Anterior segment changes secondary to inflammation and posterior ciliary nerve ablation range from acute to chronic pathology, including cataract, secondary glaucoma, and corneal decompensation. Persistent avascular retina can be present in previously treated Type 1 ROP eyes after anti-vascular endothelial growth factor or in 'normal' untreated eyes that did not previously meet Type 1 ROP criteria. Persistent avascular retina is associated with lattice-like changes, retinal tears, and detachments. The location and extent of the ridge, posterior hyaloidal contraction and adhesion, and persistent avascular retina all contribute to a spectrum of findings ranging from reactivation of neovascularization, tractional, rhegmatogenous, or exudative detachments.
Summary:
Understanding Adult ROP anatomy is critical in identification of retinal pathology and treatment choice. ROP patients require lifelong monitoring.
