Reactivation of Retinopathy of Prematurity in Adults and Adolescents

Abstract

To review the clinical features, treatment outcomes, and prevalence within our clinic population of adolescents and adults with previously regressed retinopathy of prematurity (ROP) who demonstrate late-onset exudation and vasoproliferative changes. Retrospective review of consecutive patients at a single center. Five patients (5 eyes) with a history of ROP who showed new exudates or worsening fibrovascular proliferation diagnosed after 10 years of age. Patients were identified by a computerized search of the Emory Eye Center billing records. Data extracted from charts included baseline ROP information, visual acuity and other examination findings, imaging, and treatments. Status of exudation and vasoproliferation. Among 138 patients older than 10 years with ROP seen at our tertiary referral center from 2000 through 2018, 5 (3.6%) demonstrated late-onset exudation or vasoproliferation. Three patients were female and 3 underwent ROP treatment as neonates. Mean age at onset of late reactivation was 25.6 years (range, 13-43 years). Previous treatments for neonatal ROP included peripheral laser ablation (n= 3), scleral buckle (n= 2), pars plicata vitrectomy (n= 2), and no treatment (n= 2). Management strategies for late reactivation included observation (n= 1), intravitreal anti-vascular endothelial growth factor agents (n= 4), vitrectomy (n= 2), and cryotherapy (n= 1). With mean follow-up of 4.8 years (range, 1-7 years), outcomes were resolution of exudation or proliferation with return to baseline vision (n= 2), stable mild exudation (n= 1), and progressive vasoproliferation with traction leading to phthisis (n= 2). Late-onset exudation and fibrovascular proliferation in adolescents and adults with ROP can occur rarely with previously regressed ROP. Two of 5 patients were refractory to all treatments and demonstrated phthisis bulbi. One patient showed reactivation in the form of a reactive retinal astrocytic tumor. Our findings highlight the importance continued monitoring with regular fundus examination in adolescents and adults with regressed ROP.