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RATE OF AND TIME TO COMPLETE RETINAL VASCULARIZATION IN PREMATURE INFANTS AND ASSOCIATED FACTORS
Tso-Ting Lai1,2, Chung-May Yang1, Yi-Ting Hsieh1
1Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Complete retinal vascularization in premature infants is achieved by most, but factors like lower birth weight and retinopathy of prematurity (ROP) can cause delays. Treatment for ROP may further impact vascularization timelines.
Area of Science:
- Ophthalmology
- Neonatology
- Developmental Biology
Background:
- Retinal vascularization is crucial for visual development in premature infants.
- Retinopathy of prematurity (ROP) is a significant concern in preterm neonates, potentially affecting vascular development.
- Understanding factors influencing complete retinal vascularization is key for managing ROP and ensuring optimal visual outcomes.
Purpose of the Study:
- To determine the rate and time to complete retinal vascularization in premature infants.
- To identify factors associated with delayed or incomplete vascularization.
- To explore the impact of retinopathy of prematurity (ROP) and its treatment on vascularization timelines.
Main Methods:
- Retrospective cohort study of 541 premature infants screened for ROP.
- Analysis of fundus examinations to assess complete vascularization.
- Statistical analysis to identify predictors of delayed vascularization, including birth weight and ROP status.
Main Results:
- 89.59% of infants achieved complete retinal vascularization, with an average postmenstrual age of 45.39 weeks.
- Lower birth weight, presence of ROP, and anti-vascular endothelial growth factor (anti-VEGF) therapy were associated with delayed vascularization.
- Infants without ROP had a 99.7% completion rate, compared to 66.2% for untreated ROP and 16.7% for treated ROP.
Conclusions:
- Lower birth weight is a significant predictor of delayed retinal vascularization in preterm infants.
- ROP and its treatment, particularly anti-VEGF therapy, can substantially impact the time to complete vascularization.
- These findings aid in understanding and managing persistent avascular retina in preterm infants, informing clinical practice and follow-up protocols.
Purpose:
To evaluate the rate of and time to complete vascularization in premature infants and to explore associated factors.
Methods:
A monocentric, retrospective cohort study including 541 premature infants who underwent screening for retinopathy of prematurity (ROP) between July 2016 and June 2019. Patients underwent regular dilated fundus examinations with indirect ophthalmoscopy until complete vascularization. The worse eye of each patient was included for analyses. The proportion of infants with complete retinal vascularization at the last visit and the time to full vascularization was analyzed.
Results:
Among all infants (average gestational age 31.29 ± 3.12 weeks), 490 (90.57%) had complete records of retinal vascularization outcomes, of whom 439 (89.59%) achieved complete vascularization. The average postmenstrual age for complete vascularization was 45.39 ± 11.04 weeks, and 95.22% achieved completion before 64 weeks of postmenstrual age. Retinopathy of prematurity developed in 118 (22.56%) infants; 33 (6.10%) received antivascular endothelial growth factor treatment. For all infants screened for ROP, lower birth weight, presence of ROP, and antivascular endothelial growth factor therapy predicted delayed complete vascularization; for infants diagnosed with ROP, only lower birth weight predicted delayed complete vascularization. Subgroup analysis showed significant differences between patients without ROP, with untreated ROP, and with treated ROP in time to complete vascularization and its rate (99.7%, 66.2%, and 16.7%, respectively).
Conclusion:
Lower birth weight predicted delayed complete vascularization. Antivascular endothelial growth factor therapy and the presence of ROP, including ROP severity, may also affect time to complete vascularization. These findings should help improve the understanding and management of persistent avascular retina in preterm infants.
