Severe Retinal Vascular Dysplasia in a Low-Birth-Weight Infant Born at 32 Weeks of Gestation: A Case Report

Severe retinal vascular dysplasia resembling aggressive posterior retinopathy of prematurity (ROP) can occur even in moderately preterm infants. We report the case of a male infant born at 32 weeks and 1 day of gestation, weighing 861 g, who developed advanced retinal vascular malformations. Initial management included intubation for respiratory distress syndrome, but the patient stabilized without further complications. At 36 weeks and 5 days post-menstrual age, ophthalmological evaluation revealed vascular tortuosity, abnormal anastomoses, and extensive peripheral nonperfusion in both eyes. Fluorescein angiography (FA) identified avascular regions, guiding effective bilateral retinal photocoagulation with 885 and 1,776 laser spots applied to the right and left eyes, respectively. Post-treatment follow-up showed no recurrence of retinopathy, although macular changes, specifically temporal dragging and macular scarring, persisted in the left eye. Notably, this infant did not exhibit common ROP risk factors such as oxygen toxicity or cerebral hemorrhage. In addition, genetic and neurological evaluations were unremarkable. These findings suggest a distinct etiology, potentially related to retinal vascular dysplasia rather than classical ROP. This case highlights the diagnostic value of FA in identifying avascular retinal zones and guiding treatment, especially in atypical presentations. While optical coherence tomography angiography provides high-resolution vascular imaging, FA remains a practical and effective tool in pediatric settings. Even in moderately preterm infants, comprehensive ophthalmologic evaluation should be considered based on ocular findings and clinical context, and further research is warranted to elucidate the mechanisms underlying atypical retinal vascular dysplasias.