Late-Onset Retinal Findings and Complications in Untreated Retinopathy of Prematurity

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.

Image 1:

27 yo man, 28 week GA. A, fundus photo of the right eye with a superotemporal rhegmatogenous RD secondary to multiple atrophic holes at the vascular-avascular junction, with previous laser. Note the atrophic hole temporally that is not lasered – presumably it was not present at the time of laser. B, fundus photo of the left eye of the same patient with temporal lattice-like changes and lasered atrophic hole at the vascular-avascular junction.

Image 2:

13 yo boy, 25wk gestational age, right eye treated at infancy with laser. A, fundus photo of the left eye with multiple foci of retinal neovascularization temporally and a small inferior subclinical retinal detachment. B, late phase FA with temporal leakage secondary to early retinal neovascularization and avascular periphery.

Image 3:

32 yo woman, 25wk gestational age. A, right eye with history of an inferior rhegmatogenous RD at age 20, which was repaired with scleral buckling. Note residual superotemporal visible vitreous condensation ridge-like interface. B, left eye with two superotemporal atrophic holes and a large band of residual visible vitreous condensation ridge-like interface with a shallow inferior tractional detachment.

Image 4:

33 yo woman, 28wk gestational age, right eye: A, inferotemporal retinal schisis with outer holes and a component of retinal detachment that was barricaded with laser. Superotemporal vitreous condensation ridge-like interface present. B, Late phase FA with temporal stalled vasculature and leakage along the vascular-avascular junction.

Image 5:

10 year old boy, 27 wk gestational age, right eye: A, temporal retinal detachment with residual vitreous condensation ridge-like interface, repaired with SB. B, FA after SB, with temporal stalled vasculature and many small foci of leakage – PRP lasered at a later time.

Image 6:

19 yo man, 28 wk gestational age. A, Right eye with lattice-like changes temporally and a superotemporal atrophic hole with a cuff of subretinal fluid. B, FA of the right eye with temporal leakage, note the above changes occur just anterior to the vascular-avascular junction. C, Left eye with multiple very large superotemporal and inferotemporal atrophic holes s/p laser. D, FA with the above findings just anterior to the vascular-avascular junction.