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Evaluation of the Course and Outcome of Aggressive Retinopathy of Prematurity
Shreya Raj1, Vivek Som1, Kavita Kumar1
1Ophthalmology, Gandhi Medical College, Bhopal, IND.
Insights
Aggressive retinopathy of prematurity (AROP) affects 10.5% of preterm infants, often in Zone I. Minimizing oxygen exposure and optimizing neonatal care are crucial for reducing AROP risk and progression.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Aggressive retinopathy of prematurity (AROP) is a severe form of retinopathy of prematurity (ROP).
- Understanding AROP's course, outcome, and risk factors is critical for high-risk infants.
Purpose of the Study:
- To evaluate the clinical course and outcomes of aggressive retinopathy of prematurity (AROP).
- To identify risk factors associated with the development of AROP in preterm infants.
Main Methods:
- Prospective observational study conducted on preterm infants.
- Infants underwent regular screening examinations with fundus photography for documentation.
- Parental counseling emphasized timely follow-up and periodic reviews.
Main Results:
- The incidence of ROP was 24.9%, with AROP occurring in 10.5% of cases, predominantly in Zone I.
- Significant risk factors for AROP included prolonged NICU stay, extended oxygen supplementation, and ventilatory support.
- Anti-VEGF treatment showed regression in Zone I AROP but progression in Zone II posterior AROP.
Conclusions:
- The high incidence of AROP, particularly in Zone I, necessitates vigilant screening and prompt intervention.
- Minimizing supplemental oxygen exposure and optimizing neonatal care are vital for AROP prevention and management.
Background:
This study was conducted to evaluate the course and outcome of aggressive retinopathy of prematurity (AROP) and to study the risk factors associated with AROP.
Methodology:
This was a prospective observational study, conducted in the Department of Ophthalmology, Gandhi Medical College, Bhopal, India, from August 2022 to June 2024 on preterm infants. Infants were examined in the retinopathy of prematurity (ROP) screening cubicle using aseptic precautions. All ocular findings were recorded on the proforma, and any abnormal findings were confirmed by the study guide. In cases where ROP is detected, fundus photo documentation is done. Counselling of the parents was conducted, emphasizing the importance of timely follow-up and the need for periodic reviews.
Results:
The incidence of ROP was 24.9%, while the incidence of AROP was 10.5%. Overall, AROP was detected in 107 eyes of 56 patients. Zone I was most commonly involved in 58 eyes (54.2%), followed by posterior zone II in 49 eyes (45.8%). We documented a significant association of AROP with prolonged duration of stay in the neonatal intensive care unit (NICU) (18.20±10.21 vs. 13.17±6.35 days), oxygen supplementation of more than one week (87.5% vs. 68.4%), prolonged duration of oxygen supplementation (16.50±8.34 vs. 10.50±5.2), and ventilatory support of more than one week (16.1% vs. 3.9%; p<0.05). We found regression following treatment with anti-vascular endothelial growth factor (anti-VEGF) in significantly higher proportions of cases with zone I AROP and progression following anti-VEGF in cases with zone II posterior AROP (p<0.05).
Conclusions:
The relatively high incidence of AROP, predominantly bilateral and affecting zone I, underscores the need for vigilant screening and early intervention in high-risk infants. Our findings reinforce the importance of minimizing exposure to supplemental oxygen and optimizing neonatal care practices to reduce the risk of AROP development and progression.
