Abdualrahman E Hamad1, Omar Moinuddin2, Michael P Blair3, Sidney A Schechet4, Michael J Shapiro3, Polly A Quiram5, Danny A Mammo6, Audina M Berrocal7, Supalert Prakhunhungsit7, Linda A Cernichiaro-Espinosa7, Shizuo Mukai8, Yoshihiro Yonekawa8, Cindy Ung9, Eric R Holz10, C Armitage Harper11, Ryan C Young11, Cagri G Besirli2, Aaron Nagiel12, Thomas C Lee12, Mrinali P Gupta13, Mark K Walsh14, Joseph A Khawly10, J Peter Campbell15, Andres Kychenthal16, Eric D Nudleman17, Josh E Robinson18, Mary Elizabeth Hartnett19, Charles M Calvo19, Emmanuel Y Chang20. 1. Retina and Vitreous of Texas, Houston, Texas; Henry Ford Health System, Detroit, Michigan. 2. Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor, Michigan. 3. Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois; Retina Consultants, Ltd, Chicago, Illinois. 4. Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois. 5. VitreoRetinal Surgery, PA, Minneapolis, Minnesota; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota. 6. Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota. 7. Bascom Palmer Eye Institute, University of Miami, Miami, Florida. 8. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Pediatric Retina Surgery Service, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 9. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. 10. Retina and Vitreous of Texas, Houston, Texas. 11. Austin Retina Associates, Austin, Texas. 12. USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California. 13. Department of Ophthalmology, Weill Cornell Medical College, New York, New York. 14. Retina Associates, Tucson, Arizona. 15. Casey Eye Institute, Oregon Health and Science University, Portland, Oregon. 16. KYDOFT Foundation, Santiago, Chile. 17. Shiley Eye Institute, University of California San Diego School of Medicine, San Diego, California. 18. Palmetto Retina Center, West Columbia, South Carolina. 19. John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah. 20. Retina and Vitreous of Texas, Houston, Texas. Electronic address: emanmdphd@gmail.com.
Abstract
PURPOSE: To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy. DESIGN: Retrospective, nonconsecutive, noncomparative, multicenter case series. PARTICIPANTS: Three hundred sixty-three eyes of 186 patients. METHODS: Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings. MAIN OUTCOME MEASURES: Rate of RDs and factors conferring a higher risk of RDs. RESULTS: The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009). CONCLUSIONS: Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.
PURPOSE: To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy. DESIGN: Retrospective, nonconsecutive, noncomparative, multicenter case series. PARTICIPANTS: Three hundred sixty-three eyes of 186 patients. METHODS: Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings. MAIN OUTCOME MEASURES: Rate of RDs and factors conferring a higher risk of RDs. RESULTS: The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009). CONCLUSIONS: Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patientsborn after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.
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