Abstract
BackgroundThis study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment.MethodsThis was a retrospective study. A total of 83 preterm infants (160 eyes) diagnosed with APROP who were primarily treated with IVR were included. The 160 eyes were divided into two groups based on the anatomic outcomes. Group A included 35 eyes that developed retinal detachment, and Group B included 125 eyes without retinal detachment. The following patient factors were retrospectively reviewed: gender, gestational age (GA), birth weight (BW), postmenstrual age (PMA) at first treatment, iris neovascularizations, retinal hemorrhage, neutrophil and lymphocyte counts before the first intravitreal injection, neutrophil-to-lymphocyte ratio (NLR), anatomical outcomes, additional treatment and follow-up time. Three dummy variables were created as dependent variables based on the methods of retreatment. The possible risk factors for APROP were evaluated, and statistical analyses included univariate and multivariate logistic regression.ResultsA total of 160 eyes from 83 preterm infants (56 males and 27 females) underwent initial IVR treatment with a follow-up time of 17.17 ± 10.54 months. Thirty-five of the 160 (21.9%) eyes progressed to retinal detachment, and 82 of the 125 (65.6%) non-retinal detachment eyes needed retreatment, with favorable anatomical outcomes. The disease improved approximately 1.5 ± 1.2 weeks after the first IVR treatment. The mean recurrence period of APROP was approximately 7.5 ± 6.9 weeks after the first IVR treatment. Multiple logistic regression analysis revealed postmenstrual age (P < 0.001) and neutrophil count (P = 0.009) as the most significant factors for retinal detachment in APROP. Retinal hemorrhage (P = 0.007) and BW (P = 0.04) were most significantly associated with APROP recurrence and retreatment.ConclusionsIVR injection is an effective treatment for APROP. In this study, older postmenstrual age and low neutrophil count were identified as risk factors for retinal detachment in APROP. In addition, retinal hemorrhage and low BW were significantly associated with recurrence and retreatment in non-retinal detachment APROP. Thus, patients with a lower BW, older postmenstrual age, low neutrophil count and retinal hemorrhage should be reexamined in a timely and more frequent manner.
Highlights
This study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment
Aggressive posterior retinopathy of prematurity (APROP) is a more virulent form of Retinopathy of prematurity (ROP) that is observed in more immature babies with extremely low birth weight (BW); this aggressive form affects zone I or posterior zone II
The present study investigated the efficacy of intravitreal injection of ranibizumab (IVR) for the treatment of APROP and analyzed suspected risk factors associated with tractional retinal detachment and retreatment to identify independent risk factors for the prognosis of APROP
Summary
This study sought to identify factors associated with retinal detachment and retreatment of aggressive posterior retinopathy of prematurity (APROP) initially treated with intravitreal ranibizumab (IVR) injection as well as the efficacy of IVR treatment. Retinopathy of prematurity (ROP) is a retinal vascular disorder of preterm infants that is a leading cause of childhood blindness [1]. Increased dilation and tortuosity of retinal vessels in all four quadrants and intraretinal shunting can be observed in the fundus of APROP patients. APROP does not generally progress through the classic stages 1 to 3 and can quickly lead to total retinal detachment, which causes severe visual impairment or blindness without timely treatment. Late retinal detachment is a leading cause of blindness in patients with regressed ROP during childhood [3]. Preterm newborns with APROP require effective treatment to avoid retinal detachment, which leads to unfavorable anatomical outcomes and poor sight
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