Regressed Retinopathy Of Prematurity Research Articles

Delayed macular development in preterm infants with spontaneously regressed retinopathy of prematurity

PurposeTo evaluate the macular development in preterm infants with spontaneously regressed retinopathy of prematurity (ROP) utilizing handheld spectral domain optical coherence tomography (SD-OCT) during the early postnatal period.DesignA cross-sectional observational study.MethodsUsing handheld SD-OCT, OCT images were acquired in non-sedated infants ages about 37 weeks(w) post-menstrual-age (PMA = gestational age in weeks + chronological age). Central foveal thickness (CFT), mean parafoveal thickness (PT, mean of the temporal and nasal-lateral retinal thickness 1000 μm from the foveal center), the thickness of inner retina layers (IRL) and outer retina layers (ORL) of the foveal center and parafoveal, the depth of the macular fovea (FD), and the angle of the macular fovea (FA) were measured and analyzed.ResultsIn contrast to the infants without ROP (group 1), OCT images of the infants with spontaneously regressed ROP (group 2) were more immature. The FD of Group 2 was shallower than Group 1 (P < 0.05); CFT and the foveal center IRL (FIRL) of Group 2 were thicker than Group 1 (P < 0.05); conversely, PT and the mean parafoveal IRL (PIRL) of Group 2 were thinner than Group 1 (P < 0.05); FA of Group 2 was bigger than Group 1 (P < 0.05); however, there was no significant difference in the foveal center ORL (FORL) and the mean parafoveal ORL (PORL) between Groups 1 and 2 (P > 0.05). Furthermore, in preterm infants, ROP was moderately correlated with FD, CFT, PT, FIRL, and PIRL (P < 0.05).ConclusionsThe spontaneously regressed ROP resulted in immature macular development in the early postnatal period. The inner retinal layers mainly contribute to this but not the outer retinal layers, indicating that the macular fovea’s inner and outer retina layers developed asynchronously. ROP is an influential factor in macular development and maturation. This may be associated with the higher probability of visual impairment in children with a history of spontaneous regression of ROP at a prior time.

Surgical Outcomes of Rhegmatogenous Retinal Detachment Associated with Regressed Retinopathy of Prematurity.

To evaluate the characteristics and surgical outcomes of late-onset rhegmatogenous retinal detachment (RRD) associated with regressed retinopathy of prematurity (ROP) and the status of fellow eyes. Retrospective review of consecutive cases undergoing surgery for regressed ROP-related RRD and the fellow eyes between 2012-2022. Demographic data, fundus findings, retinal detachment characteristics, surgical procedures, and anatomic and functional outcomes were analyzed. Anatomic success was defined as retinal attachment after silicone oil removal at final follow-up. Fifteen eyes of 14 patients with a history of regressed ROP underwent surgical repair for RRD at a mean age of 12 (range, 3-26) years. Primary surgical intervention yielded a 53% failure rate overall. This rate was 33% for scleral buckling (SB), 100% for pars plana vitrectomy (PPV), and 40% for combined SB-PPV surgery. Eyes with posterior cicatricial changes and/or proliferative vitreoretinopathy (PVR) demonstrated a higher tendency for recurrence. The final anatomic success rate was 73% after a mean number of 2.3 (range, 1-5) surgeries. The chances of restoring useful vision diminished with repeated surgery despite the improvement in anatomic success. In the fellow eyes, peripheral retinal pathologies were universally observed, with posterior cicatricial changes noted in 33%. The study reveals a significant initial failure rate in surgical treatment of cases with late-onset RRD associated with regressed ROP, particularly in eyes with posterior cicatricial changes or PVR, suggesting the need for a combined surgical approach as an initial strategy in such high-risk cases. The consistent presence of retinal abnormalities in fellow eyes calls for proactive monitoring and potential prophylactic intervention.

Long-term visual outcomes in children with regressed retinopathy of prematurity

This retrospective study evaluated long-term visual outcomes in children with regressed retinopathy of prematurity (ROP) and correlations between visual acuity (VA) and clinical variables, including fundus findings. We reviewed the medical records of 57 consecutive patients diagnosed with ROP. We analyzed the correlations between best-corrected VA and anatomical fundus findings, such as macular dragging and retinal vascular tortuosity, after ROP regression. The correlations between VA and clinical variables such as gestational age (GA), birth weight (BW), and refractive errors (hyperopia and myopia in spherical equivalent [SE], astigmatism, and anisometropia) were also evaluated. Of 110 eyes, 33.6% had macular dragging; the presence of macular dragging and poor VA were significantly correlated (p = 0.002). Patients with larger macula-to-disc distance/disc diameter ratios had significantly poorer VA (p = 0.036). However, no significant correlation was observed between the VA and vascular tortuosity. Patients with smaller GA and BW had poorer visual outcomes (both, p = 0.007). The larger SE in absolute values, myopia, astigmatism, and anisometropia were significantly associated with poorer visual outcomes as well (all, p < 0.001). In children with regressed ROP, macular dragging, small GA and BW, large SE in absolute values, myopia, astigmatism, and anisometropia may be predictors of poor visual outcomes at early ages.

Late Vitreoretinal Complications of Regressed Retinopathy of Prematurity: Retinal Break, Vitreous Hemorrhage, and Retinal Detachment

To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment. International, multicenter, noncomparative retrospective case series. We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP. Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared. Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP. A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P= 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement. Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients.

Swept-Source Optical Coherence Tomography in Preschool Children with a History of Treated or Spontaneously Regressed Retinopathy of Prematurity

ABSTRACTPurposeTo evaluate the best-corrected visual acuity (BCVA), the spherical equivalent (SE), and the central, parafoveal, and perifoveal macular thickness results of the children with a history of treated or spontaneously regressed retinopathy of prematurity (ROP).MethodsSeventy-nine right eyes of 79 children at the age of 5 years old were included in this cross-sectional observational study. Twenty-four infants who received intravitreal bevacizumab (IVB) were in group 1, 27 infants who underwent laser photocoagulation (LPC) were in group 2, and 28 infants who had spontaneous regression were in group 3. Central foveal thickness (CFT) and the thicknesses of four parafoveal and four perifoveal quadrants as superior, temporal, inferior, and nasal were analyzed by using swept-source optical coherence tomography (SS-OCT).ResultsBCVA was significantly better (p = .002), and the SE was significantly higher in group 3 than in both groups 1 and 2 (p = .033). CFT was significantly lower in group 3 than in both groups 1 and 2 (p < .001). The parafoveal average, temporal, inferior, and nasal thickness values and the perifoveal average, superior, and temporal thickness results were significantly higher in group 2 than in both groups 1 and 3 (p = .003, p = .002, p = .009, and p = .009, respectively) (p = .003, p < .001, and p = .007, respectively).ConclusionCFT was significantly higher in infants who had treatment for ROP. Parafoveal and perifoveal retinal thicknesses in certain quadrants were higher in those receiving LPC treatment than in others. CFT was negatively correlated with both gestational age and birth weight. Myopia was seen more often in children who had treatment.

Fluorescein Angiography Findings in Treatment-Naive Premature Infants with Retinal Vascular Immaturity and Persistent Avascular Retina

ABSTRACTPurposeTo evaluate the fluorescein angiography (FA) findings in eyes with spontaneously regressed retinopathy of prematurity (ROP).MethodsFluorescein angiography images of 162 eyes of 81 treatment-naive infants who underwent FA due to retinal vascular immaturity and persistent avascular retina (PAR) despite exceeding postmenstrual age of 60 weeks were analyzed retrospectively. Disc diameter (DD), optic disc-to-fovea distance (FD), the length of temporal retinal vascularization (LTRV), and the length of measurable temporal avascular retina distance (LMTAR), were quantitatively measured.ResultsThe mean gestational age and FA imaging age were 29.39 ± 3.13 and 86.51 ± 24.80 weeks postmenstrual, respectively. The mean ratios of LTRV/FD and LMTAR /DD were 4.47 ± 0.36 and 2.21 ± 1.01, respectively. Pigmentary changes were detected in the peripheral retina in 21% of the eyes. There was at least one angiographic finding in 88% of the eyes, but these findings were usually mild. Based on the FA findings, laser photocoagulation was performed to the peripheral avascular retina in ten eyes of five patientsConclusionEven in larger preterm infants and without severe retinopathy and anti-VEGF treatment, PAR and peripheral pigmentary changes may be detected, and mild angiographic vascular activity may continue. These findings may lead to late-onset retinal pathologies that may threaten vision. In eyes with PAR, follow-up with FA and prophylactic laser application may be applicable. Further investigation is required for this topic.

Long-term visual outcomes of children screened for retinopathy of prematurity with telemedicine in New Zealand

ABSTRACT Clinical Relevance Children with a history of regressed retinopathy of prematurity (ROP) are at increased risk of peripheral avascular retina. Wide-field digital retinal imaging and telemedicine is an effective tool for ROP screening. Ophthalmologists and Optometrists should have a high level of clinical suspicion for peripheral retinal changes in children screened for ROP. Background Retinopathy of prematurity, a vaso-proliferative disorder of the pre-term retina, is a preventable cause of childhood visual impairment. The Auckland Regional Telemedicine ROP (ART-ROP) network, established in 2006, utilises wide-field digital imaging and telemedicine to screen at-risk infants for ROP. This prospective observational study reports the long-term ocular outcomes of ART-ROP network infants. Methods A comprehensive paediatric eye examination including cycloplegic autorefraction and wide-field retinal imaging was completed on all participants. Participants had been screened for ROP by the ART-ROP network between May 2008 and October 2011. Results A total of 69 children, with a mean age of 5 to 8 years old were assessed and divided into two groups: those with or without a history of ROP, 44 and 25 children, respectively. Infants with a history of ROP had significantly lower gestational age (26.6 ± 1.9 vs. 29.1 ± 1.6 weeks, p < 0.001) and birth weight (937 ± 237 vs. 1177 ± 311 grams, p = 0.001). No significant differences were detected between the two groups for visual acuity (p = 0.596), stereopsis (p = 0.219), refractive error (p = 0.472), or strabismus. Clinically significant refractive error was noted in 10 participants; none with moderate or high myopia. Retinal imaging exposed asymptomatic, persistent, peripheral avascular retina in four children, all of whom had a history of regressed ROP. Conclusion Visual and ocular outcomes did not vary based on history of ROP, with no participant having reduced vision as a result of undetected or untreated ROP. Further research is required into the long-term implication of persistent avascular retina in regressed ROP.

Reactivation of Retinopathy of Prematurity in Adults and Adolescents

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.

Cone-Mediated Function Correlates to Altered Foveal Morphology in Preterm-Born Children at School Age.

To correlate cone- and rod-mediated function with morphology of the macula in preterm-born children without and with spontaneously regressed retinopathy of prematurity (ROP). We performed spectral-domain optical coherence tomography (SD-OCT) single scans in the macular center of preterm-born children aged 6 to 12 years (mean ± SD, 7.4 ± 1.8) without ROP (noROP; n = 59) and with spontaneously regressed ROP (srROP; n = 34), documented with wide-angle digital imaging during routine screening for acute ROP, and compared the data from 14 age-matched term-born children. SD-OCT data were compared to functional cone- and rod-mediated results of scotopic and photopic chromatic pupillometry (cP) and two-color fundus-controlled perimetry (2C-FCP). SD-OCT showed a shallowed foveal pit with significantly reduced outer nuclear layer to inner retinal layer ratio, indicating macular developmental arrest (MDA). MDA was present in 44% of the srROP and 27% of the noROP children. Pupil reaction to photopic red stimuli on blue background showed significantly lower values in all preterm-born children with MDA. In accordance, photopic light increment sensitivity (LIS) to red stimuli in the foveal center on the 2C-FCP was also significantly reduced in children with MDA. Under scotopic conditions, no significant differences were apparent in both pupil reaction with cP and LIS with 2C-FCP. Both objective pupillary response to cone-mediated photopic red stimuli and subjective central cone-mediated results in fundus-controlled perimetry were reduced in preterm-born children with MDA. MDA was present in a significant number of patients with srROP, but also without ROP.

OCT Angiography in Young Children with a History of Retinopathy of Prematurity

To describe the size and appearance of the foveal avascular zone (FAZ) in the superficial and deep plexus in young children with treated or spontaneously regressed retinopathy of prematurity (ROP), in comparison with age-matched controls and young adults, as seen with OCT angiography (OCTA), and to compare these parameters with foveal classic OCT images and visual function. Prospective, cross-sectional study. Twenty-five children with treated or spontaneously regressed ROP (mean 5.0±0.8 years) compared with 15 healthy term-born age-matched children and 20 healthy adults. OCTA was performed using a DRI OCT Triton (Swept Source OCT, Topcon, Oakland, NJ). The best-quality images of 1 eye per patient were analyzed. Superficial FAZ and deep FAZ were analyzed separately. Single-scan OCTs were performed using a Spectralis SD-OCT (HRA+OCT, Heidelberg Engineering, Heidelberg, Germany). The foveal pit characteristics and the degree of macular developmental arrest (MDA), defined as the ratio of the outer nuclear layer+ external limiting membrane (ONL+) and the inner retinal layers in the fovea (ONL+/IRL-ratio), were analyzed with a custom-made automated layer segmentation tool (DiOCTA, copyright by Justus-Liebig-University, Giessen, Germany). Visual acuity (VA) was tested with Early Treatment of Diabetic Retinopathy Study letter charts. The ONL+/IRL-ratio, superficial FAZ area, deep FAZ area, foveal parameters, and VA. Foveal pit depth and area were significantly reduced in both treated and spontaneously regressed ROP, whereas the foveal diameter was comparable in all groups. OCTA showed a significantly narrowed superficial FAZ in eyes with treated and spontaneously regressed ROP. In contrast, the deep FAZ was of comparable size in all groups. A reduced superficial FAZ significantly correlated with reduced ONL+/IRL-ratio, and thus the degree of MDA. In treated and spontaneously regressed ROP, reduced superficial FAZ and MDA correlated significantly with diminished VA. OCTA is feasible in young children with a history of ROP and without neurodevelopmental delay. It allows detecting a decreased superficial FAZ size noninvasively. A small superficial FAZ, reduced ONL+/IRL-ratio as a measure of MDA, and reduced VA are concurrent factors in preterm children who are otherwise neurologically normal.

Development of Refractive Error in Individual Children With Regressed Retinopathy of Prematurity

We investigated longitudinally the refraction development in children with regressed retinopathy of prematurity (ROP), including those with and those without a history of peripheral retinal laser photocoagulation. Longitudinal (0-7 years) cycloplegic refraction data were collected prospectively for two groups of preterm children: severe ROP group included those with regressed ROP following bilateral panretinal laser photocoagulation (n = 37; median gestational age [GA] = 25.2; range, 22.7-27.9 weeks) and mild/no ROP group included those with spontaneously regressed ROP or no ROP (n = 27; median GA = 27.1; range, 23.1-32.0 weeks). Analyses were based on spherical equivalent (SEQ), anisometropia, astigmatism, and age (corrected for gestation). The prevalence, magnitude, and rate of myopic progression all were significantly higher in the severe ROP group than in the mild/no ROP group. Longitudinal SEQ in the severe ROP group were best fit with a bilinear model. Before 1.3 years old, the rate of myopic shift was -4.7 diopters (D)/y; after 1.3 years, the rate slowed to -0.15 D/y. Longitudinal SEQ in the mild/no ROP group was best fit with a linear model, with a rate of -0.004 D/y. Anisometropia in the severe ROP group increased approximately three times faster than in the mild/no ROP group. In the severe ROP group, with-the-rule astigmatism increased significantly with age. The severe ROP group progressed rapidly toward myopia, particularly during the first 1.3 years; anisometropia and astigmatism also increased with age. The mild/no ROP group showed little change in refraction. Infants treated with laser photocoagulation for severe ROP should be monitored with periodic cycloplegic refractions and provided with early optical correction.

Risk of Refractive Pathology After Spontaneously Regressed ROP in Emmetropic Patients

To evaluate the development of refractive error abnormalities after a normal first examination in children with spontaneously regressed retinopathy of prematurity (ROP). Two hundred twenty-six children with a history of spontaneously regressed ROP who had a cycloplegic refraction prior to 18 months of age were examined by a pediatric ophthalmologist. Children with a history of threshold ROP, strabismus, or a structural abnormality of the eye were excluded. A normal cycloplegic retinoscopy was defined as plano to less than +3.5 diopters of hypermetropia, less than +1.50 of symmetric astigmatism, and no anisometropia greater than 1.5 diopters in any meridian. Of the 226 children, 87 had a second examination and cycloplegic refraction at a mean of 2 years after the initial visit. In 63 of the children, the second examination and refraction remained normal. Three (3.4%) children had significant refractive error and were treated with spectacles: two had anisometropia and one had myopic astigmatism. Twenty-one had symmetric low magnitude myopia that did not warrant treatment. Children with spontaneously regressed ROP and no significant refractive error on cycloplegic retinoscopy at first follow-up examination have a risk of developing ametropia that is similar to that of the general population. Such children can likely be observed with a verbal vision screening in the pediatrician's office at 3 to 4 years of age.

Late vitreous hemorrhage in patients with regressed retinopathy of prematurity

To describe the characteristics of eyes with late vitreous hemorrhage in children with a history of regressed retinopathy of prematurity (ROP). The medical records of consecutive patients with regressed ROP presenting to our institution with late vitreous hemorrhage between 1995 and 2006 were reviewed. Thirteen patients (14 eyes) were identified. All patients had stage 3 or higher ROP. Prior treatments included cryotherapy in three eyes, laser ablation in eight eyes, and laser followed by vitrectomy for retinal detachment in two eyes. Three eyes had had no prior ocular surgery. Age at late vitreous hemorrhage ranged from 10.8 months to 15 years (mean, 8.4 years). At the time of late vitreous hemorrhage, no eyes had active neovascularization, three eyes had a history of trauma, and three eyes had concurrent retinal detachment; eight eyes were observed (57%) and six (43%) were treated with vitrectomy. Late vitreous hemorrhage can occur in patients with regressed ROP years after the vascularly active phase of the disease. It likely results from abnormal vitreoretinal traction on otherwise normal retinal vessels or from a normal amount of traction on residual cicatricial tissue. Vitreous hemorrhage may occur in the absence of trauma, retinal tears, retinal detachment, or active neovascularization. With appropriate management, most patients maintained their baseline vision.

Retinal detachment of regressed retinopathy of prematurity in children aged 2 to 15 years.

To reveal the clinical features and surgical results of retinal detachment of regressed retinopathy of prematurity (ROP) that occur in the children aged 2 to 15 years. The records of patient who had a retinal detachment of a regressed ROP were retrospectively reviewed. Sixteen eyes from 15 patients that required surgical treatments due to retinal detachment of a regressed ROP were included. After treatment of acute phase of ROP, eight eyes showed grade II of cicatricial change and eight eyes showed grade III. We did not find any evidence that the acute stages of ROP and its treatment affect the degree of the cicatricial changes. All eight eyes with grade III of cicatricial ROP showed tractional retinal detachment (TRD) and five of eight eyes (62.5%) with grade II showed rhegmatogenous retinal detachment (RRD). The mean interval between regressed ROP and development of late retinal detachment was 20.7 months (range, 12-61 months) in the TRD group and 85.8 months (range, 33-148) in the RRD group. The mean age at onset of late detachment was 34.1 months (range, 26-73 months) in the TRD group and 98.6 months (range, 45-162) in the RRD group. Anatomical success was achieved at one of five eyes (20%) with RRD and six of 11 eyes (54.5%) with TRD. Compared with the preoperative visual acuity, visual improvement, no change, and decreased visual acuity were achieved, respectively, in two eyes, three eyes, and no eyes in the RRD group and three eyes, six eyes, and two eyes in the TRD group. However, only two of 16 eyes with late retinal detachment achieved a visual acuity of 20/200 or better. Late retinal detachment is the main vision-threatening condition in patients with regressed ROP during childhood. The visual prognoses of these patients are poorer than those with late retinal detachments that occur in adult ROP patients. Therefore, a periodic fundus examination should be performed more frequently during childhood than in adulthood, particularly in nonverbal children.

Late-onset retinal detachment associated with regressed retinopathy of prematurity

Purpose: To study the characteristics of late-onset retinal detachments in patients with regressed retinopathy of prematurity (ROP) and the condition of their fellow eyes. Methods: We carried out a retrospective review of 29 patients (38 eyes) who had been treated at two institutions, one in the US and the other in Japan, between 1986 and 1997. The age at the time of treatment ranged from 6 to 51 years (mean = 23.1). Five of the 38 eyes with tractional detachment were treated with either open-sky vitrectomy, closed vitrectomy, or scleral buckling; 27 of the 38 eyes with rhegmatogenous retinal detachment underwent scleral buckling or closed vitrectomy or both. The remaining 6 of the 38 eyes had subclinical rhegmatogenous detachment and were treated with photocoagulation or cryopexy, or followed without treatment. The most characteristic retinal breaks were multiple holes with a prevalence of equator and posterior types. Results: Overall, anatomical reattachment was accomplished in 27/32 eyes (84%) that underwent surgery. Two thirds of the patients who underwent vitrectomy either initially or at a later time had poor postoperative visual acuity. More than half of the fellow eyes had retinal detachment and others had various characteristic fundus changes of regressed ROP. Conclusions: Long-term, probably life-long follow-up of high-risk patients is necessary so that diagnosis and treatment can be instituted at an early stage of retinal detachment.

Ocular findings in former premature infants at the age of 11 to 14 years

Functional disturbances as well as morphologic changes can be various in regressed retinopathy of prematurity (ROP). To investigate the incidence and the degree of such changes, we examined prematurely born infants in the age of 11 to 14 years. Of the 142 prematures (birthweight < or = 2000 g), who were cared for in their first weeks of life in the University Children's Hospital at the Klinikum Mannheim in 1977 to 1979, 48 could be reexamined. Of 48 infants (mean birth weight 1808 +/- 211 g, gestational age 34.6 +/- 3.1 weeks) six (12.5%; birth weight 1742 +/- 218 g, gestational age 32.2 +/- 2.5) had had acute ROP (stage 2 or 3). When reexamined in school age 10 (21%) of the children had physical deficits. Eight (17%) visited a school for handicapped children. Eight (17%) children had a squint. In 13 out of 96 (14%) eyes visual acuity was reduced to 0.8 or less. Thirteen eyes (14%) were emmetropic, 67 (70%) hyperopic, 16 (17%) myopic and 15 (16%) astigmatic. The intraocular pressure was normal in all eyes (15 +/- 4 mm Hg). The anterior segments did not show findings caused by ROP. The fundus findings in the 12 eyes, in which the diagnosis of acute ROP was established in the first weeks of life, showed in 5 (42%) eyes a slightly reduced angle kappa between the vascular arcades and avascular retina in the temporal fundus periphery in all of the 12 (100%) eyes. In 1 (8%) eye the retinal periphery showed extensive scarring after cryotherapy because of acute ROP. None of the eyes which had had acute ROP showed macular ectopia or retinal folds (amotio falciformis). In 16 of the 84 (19%) eyes, which did not have a history of acute ROP, minor changes of the retinal periphery, the peripheral retinal vessels and the pigment epithelium were present, which were caused by prematurity. Prematurely born infants examined in school age, who were comparatively mature preterms at birth (mean birth weight 1800 g; mean gestational age 34.6 weeks), did not show a higher risk of refractive errors, i.e. myopia. However, they were at higher risk having squint. The functional disturbances found in the prematurely born infants in this study were not caused by morphologic changes due to ROP.

Perinatal predictors of ocular morbidity in school children who were very low birthweight

Two hundred children from one neonatal intensive care unit (NICU), who were very low birthweight (VLBW), were examined at approximately 9 years of age and compared with a control group of normal birthweight children. Visual morbidity was significantly higher among children who were very low birthweight. Binocular visual acuity of 6/9 or worse was noted in 21 (10.5%), strabismus in 38 (19%) and regressed retinopathy of prematurity (ROP) in 13 (6.7%) of these children. A history of seizures in the perinatal period was highly correlated with poor visual acuity. Independently significant factors associated with strabismus included clinically diagnosed intraventricular haemorrhage, a maternal history of neonatal death, transfer from another hospital, bronchopulmonary dysplasia and necrotising enterocolitis. Perinatal variables that correlated with regressed ROP included birthweight, time from birth to admission to the NICU, necrotising enterocolitis and a history of maternal smoking during the pregnancy. When screening for ocular abnormalities among children who were born preterm, particular attention should be given to children with these risk factors.

Regressed retinopathy of prematurity in children aged 5-10 years.

Regressed retinopathy of prematurity (ROP) and its sequelae has been analysed in pre-term born children with a birth weight < 1500 g and/or < 33 weeks of gestational age, born in Stockholm during 1976-81. At the age of 5-10 years, we found that 134 of 528 preterm born children (25.4%) had been at departments of ophthalmology in Stockholm for various reasons. These children were re-examined and a good eye fundus information could be obtained in 105. Moderate and severe regressed ROP was found in 48 and 13 children, respectively. In the Stockholm area the frequency of children with severe ROP (earlier called cicatricial ROP) was 2.5% out of the above risk group of 528. Two children were blind from ROP (0.4%). Ten children had a visual acuity < or = 0.3 in the worse eye (1.9%) and 7 of them had ROP changes. Children with a birth weight < 1000 g had the highest frequency of ROP (severe 11.6% and moderate 18.6%) and ocular complications. The results show that preterm born children often present ocular complications, and therefore they need a close follow-up.

Regressed retinopathy of prematurity and its sequelae in children aged 5-10 years.

Regressed retinopathy of prematurity (ROP) and its sequelae were studied in children born prematurely (less than 1501 g birth weight and/or less than 33 weeks gestational age) in Stockholm county during 1976-81. Through various searches of the records at the different eye departments and other sources in Stockholm county we found that 134 out of a total of 528 premature babies (25.4%) had needed ophthalmic care for different reasons. They were re-examined and reliable information on the fundus could be obtained for 105 of them. The frequency of regressed ROP was 45.5%. Severe forms with vitreoretinal scarring and retinal traction were seen in 9.7% of cases and moderate forms with pigmentary changes and/or vitreoretinal interphase changes in 35.8%. The sequelae of regressed ROP were mainly reduction of visual acuity and myopia. Children with a birth weight below 1000 g and a gestational age less than 30 weeks presented the highest rate of regressed ROP (68.5% and 61.9%) and ocular abnormalities.

Surgical Management of Lateonset Retinal Detachments Associated with Regressed Retinopathy of Prematurity

The authors report their experience in managing 16 cases of lateonset retinal detachments (RDs) associated with regressed retinopathy of prematurity (ROP). Fourteen (88%) of the 16 eyes were successfully reattached. An initial scleral buckling procedure was successful in 6 of 12 eyes. A pars plana vitrectomy was necessary in a total of eight eyes that either initially presented with proliferative vitreoretinopathy (1 case), posterior retinal breaks (1 case), subretinal fibrosis (1 case), vitreoretinal traction bands (1 case), or had persistent vitreoretinal traction after failed scleral buckling procedures (4 cases). Visual acuity stabilized or improved in 13 of the 14 eyes with successful retinal reattachment. Because these cases often have significant vitreoretinal traction and/or posterior retinal breaks, pars plana vitrectomy in conjunction with scleral buckling may be necessary in order to achieve long-term retinal reattachment.