Persistent Vascular Anomalies in Retinopathy of Prematurity Children: Ultrawide-field Fluorescein Angiography Findings until School Age

Xiao Chun Ling; Eugene Yu-Chuan Kang; Jhen-Ling Huang; Hung-Da Chou; Laura Liu; Chi-Chun Lai; Kuan-Jen Chen; Yih-Shiou Hwang; Wei-Chi Wu

doi:10.1016/j.xops.2023.100281

Persistent Vascular Anomalies in Retinopathy of Prematurity Children: Ultrawide-field Fluorescein Angiography Findings until School Age

Ophthalmol Sci. 2023 Feb 7;3(3):100281. doi: 10.1016/j.xops.2023.100281. eCollection 2023 Sep.

Authors

Xiao Chun Ling¹, Eugene Yu-Chuan Kang¹, Jhen-Ling Huang², Hung-Da Chou^{1

3}, Laura Liu^{1

3}, Chi-Chun Lai^{1

4}, Kuan-Jen Chen^{1

3}, Yih-Shiou Hwang^{1

3}, Wei-Chi Wu^{1

3}

Affiliations

¹ Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
² Center of Statistics and Big Data, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
³ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴ Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Abstract

Purpose: To investigate vascular abnormalities, including persistent avascular retina (PAR), in a large cohort of patients with regressed or treated retinopathy of prematurity (ROP) through long-term follow-up until school age.

Design: Retrospective large cohort study.

Participants: We included pediatric patients (< 18 years old) with a history of nontreated or treated ROP (treated with either photocoagulation or intravitreal injection [IVI]) and regularly followed up until 2020.

Methods: Upon enrollment, we categorized patients into 4 groups: prematurity, regressed ROP, and IVI and laser treatment ROP groups. All patients had undergone visual acuity examinations, OCT, and ultrawide-field fluorescein angiography.

Main outcome measures: Percentage of eyes with PAR (greater than or equal to the area of 2 disc diameters from the ora serrata to vascular termini) and with vascular abnormalities in the peripheral and posterior retina.

Results: In total, we included 187 eyes of 95 patients. The prevalence of PAR was 0%, 33.33%, and 31.65% in eyes in the prematurity, regressed ROP, and IVI treatment groups, respectively (P < 0.0001). There was no significant difference in the percentage of PAR eyes when comparing regressed ROP group (33.33%) with the IVI treatment group (31.65%). At least 1 type of vascular abnormality was noted until school age in all (100%) treated ROP eyes. Although multivariate analysis found a significant association between IVI treatment and PAR (odds ratio: 10.28, 95% confidence interval: 3.29-32.14) until the school age of 6 to 8 years old, there were no stage 3 eyes in the spontaneously regressed group, suggesting that stage 3 ROP in the IVI group could also drive the association.

Conclusions: Approximately one-third of ROP eyes with spontaneous regression or IVI treatment still exhibit PAR when the child reaches school age. Several distinct vascular anomalies at the vascular-avascular juncture and within the vascularized retina can persist in these children. The clinical significance of these anomalies and the decision whether to treat them warrant further investigation to optimize their outcomes.

Financial disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.

Keywords: Persistent avascular retina; Retinopathy of prematurity; Ultra-widefield angiography; Vascular anomalies.