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Persistent avascular retina in retinopathy of prematurity
Ting Fang Tan1, Su Ann Tay1,2, Swati Agarwal-Sinha3
1Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.
Insights
Persistent avascular retina (PAR) is increasingly seen in retinopathy of prematurity (ROP) and may persist beyond screening. Early detection and monitoring are crucial for managing potential complications like retinal tears.
Area of Science:
- Ophthalmology
- Retinal Vascular Diseases
Background:
- Persistent avascular retina (PAR) is increasingly reported in retinopathy of prematurity (ROP), particularly with anti-vascular endothelial growth factor (VEGF) treatments.
- PAR is now recognized in the International Classification of Retinopathy of Prematurity, 3rd edition (ICROP3), highlighting its clinical significance.
Purpose of the Study:
- To emphasize the growing importance of detecting and understanding Persistent Avascular Retina (PAR) in Retinopathy of Prematurity (ROP).
- To highlight the association of PAR with potential complications and the need for revised management strategies.
Main Methods:
- Review of clinical observations and updated nomenclature regarding PAR in ROP.
- Discussion of diagnostic tools like fluorescein angiography and wide-field imaging for monitoring retinal vascularization.
- Exploration of the natural course of retinal vascularization and anti-VEGF effects.
Main Results:
- PAR is observed in both treated and untreated ROP, sometimes regressing spontaneously.
- Posteriorly located PAR is associated with increased risk of retinal tears and detachment.
- Current screening guidelines may not adequately cover the persistence of PAR.
Conclusions:
- Further research is needed to establish consensus on the follow-up and management of PAR in ROP.
- Understanding the natural history of vascularization and the impact of anti-VEGF agents is critical for guiding clinical protocols.
- Serial monitoring for complications associated with PAR is encouraged.
Abstract:
Persistent avascular retina (PAR) has been increasingly reported with the increased use of anti-vascular endothelial growth factor (VEGF) agents in treatment-requiring ROP. However, they have also been observed in ROP eyes that did not meet treatment requirement and spontaneously regressed. PAR is highlighted in the updated nomenclature under the International Classification of Retinopathy of Prematurity, 3rd edition (ICROP3) consensus statement, underscoring the increased emphasis in detecting PAR. PAR has been noted to persist beyond existing ROP screening guidelines, and were found to be associated with complications like retinal tear and detachment, especially in eyes with more posterior PAR. Thus, serial monitoring of retinal vascularization, facilitated by fluorescein angiography and wide-field imaging, for these associated complications have been encouraged. The current lack of consensus in the follow-up and management of PAR prompts further work in this area: understanding the natural course of retinal vascularization in both untreated and treated ROP, the modulation of anti-VEGF on retinal function, and the clinical significance of PAR-associated vascular patterns can help to guide management protocols for PAR in ROP eyes.
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