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Postnatal retinal vascularization in former preterm infants with retinopathy of prematurity
H A Mintz-Hittner1, F L Kretzer
1Department of Ophthalmology, Baylor College of Medicine, Houston 77030.
Insights
Former preterm infants with regressed retinopathy of prematurity (ROP) show increased macular ectopia and vessel traction. Close monitoring of the peripheral retina is crucial for early detection of retinal detachments in these high-risk patients.
Area of Science:
- Ophthalmology
- Retinal Vascular Diseases
- Neonatal Care
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Spontaneous regression of ROP can still lead to long-term retinal complications.
- Understanding the cicatricial outcomes of regressed ROP is essential for patient management.
Purpose of the Study:
- To investigate the long-term vascular and structural changes in the peripheral retina of preterm infants with spontaneously regressed ROP.
- To correlate cicatricial outcomes with the severity of the initial ROP stage.
Main Methods:
- Retrospective analysis of fundus photographs and fluorescein angiograms from 133 eyes of 72 former preterm infants.
- Quantification of macular ectopia, vessel traction, radial vascularization length, and capillary scaffolding.
- Comparison of cicatricial parameters with the documented worst ROP stage.
Main Results:
- Increased severity of initial ROP correlated with greater macular ectopia and vessel traction.
- Higher ROP stages were associated with decreased radial length and capillary scaffolding of the postnatally vascularized retina.
- Retinal holes were frequently observed in eyes with high myopia.
Conclusions:
- The peripheral retina in former preterm infants with regressed ROP requires vigilant monitoring for potential late rhegmatogenous retinal detachments.
- Persistent retinal traction may contribute to the formation of retinal holes in the anterior, undifferentiated retina.
- Early detection and management of these complications are vital to prevent vision loss.
Purpose:
To study the postnatally vascularized retina in former preterm infants in whom retinopathy of prematurity (ROP) stages 2 to 4a developed and spontaneously regressed.
Methods:
Matched fundus photographs and fluorescein angiograms of the temporal peripheral retinas of 133 eyes (72 patients) were obtained after 2 years of age (mean, 7.7 years; range, 2-16.2 years) and were quantified by two masked observers with respect to the following parameters: (1) macular ectopia (in disc diameters); (2) vessel traction (in 30 degrees sectors); (3) radial length of postnatally vascularized retina (in disc diameters); and (4) capillary scaffolding of postnatally vascularized retina (as a density). These cicatricial outcomes were then compared with their active worst ROP stage.
Results:
Of the 133 retinal montages, the following active worst ROP stages had been documented: 30 with stage 2, 42 with stage 3 mild, 32 with stage 3 moderate, 20 with stage 3 severe, and 9 with stage 4a. As active worst ROP stage increased, macular ectopia and vessel traction increased, and radial length and capillary scaffolding of postnatal retinal vascularization decreased. Retinal holes were documented frequently in eyes with high myopia.
Conclusions:
The peripheral retina in former preterm infants warrants close scrutiny for possible late rhegmatogenous retinal detachments. Prolonged retinal traction (by remnant shunt and extraretinal fibrovascular proliferation) between stable, posterior, prenatally vascularized retina, and unstable, postnatally vascularized retina may lead to the development of retinal holes characteristically located in the fragile, anterior, undifferentiated, nonvascularized retina.
