Evolution of Retinal Detachment in Posterior Retinopathy of Prematurity: Impact on Treatment Approach

Abstract

To provide insight into the course of retinal detachment in eyes with aggressive posterior retinopathy of prematurity (APROP). Prospective, multicenter, masked clinical trial. Multicenter trial based on serial digital photographic imaging detailing five infants (in the Photographic Screening for Retinopathy of Prematurity [PHOTO-ROP] Study) in whom bilateral retinal detachment developed during the course of the study. Retinal detachment developed in both eyes (n=10) of all five infants despite peripheral retinal laser ablation. The mean birth weight was 651.4+/-45.30 g (range, 601 to 718 g), and the mean gestation was 26.75+/-0.96 weeks (range, 24 to 26 weeks). APROP (flat neovascularization) was present in all eyes at the time of treatment. Laser treatment was performed at a mean postconceptual age of 37.25+/-1.8 weeks (range, 35 to 39.57 weeks). Plus disease resolved initially and then recurred (mean, 9.5 days) with progression to retinal detachment; the mean postconceptual age at the time of retinal detachment was 41.42+/-3.6 weeks (range, 36 to 47.29 weeks). Untreated avascular retina became visible with regression of flat preretinal neovascularization. All 10 eyes showed preretinal vitreous organization (most prominent nasally) along the retinal surface without significant transvitreal components. Eyes with APROP may follow an atypical course after laser ablation. Such eyes may still fare poorly, even when plus disease wanes. Additional laser to avascular retina may be necessary after the overlying flat stage 3 neovascularization regresses. The absence of obvious fibrosis at the time of laser should provide no reassurance as to reduced probability of progression to retinal detachment.