Evaluation of the Course and Outcome of Aggressive Retinopathy of Prematurity

TL;DR

This study examines the progression and risk factors of aggressive retinopathy of prematurity in preterm infants to improve early detection and treatment.

Contribution

The study identifies specific risk factors and treatment outcomes for aggressive retinopathy of prematurity in a clinical setting.

Findings

AROP was detected in 10.5% of preterm infants, with zone I being the most commonly affected area.

Prolonged NICU stay and oxygen supplementation were significantly associated with AROP development.

Anti-VEGF treatment showed regression in zone I AROP but progression in posterior zone II AROP.

Abstract

Background: This study was conducted to evaluate the course and outcome of aggressive retinopathy of prematurity (AROP) and to study the risk factors associated with AROP.

Methodology: This was a prospective observational study, conducted in the Department of Ophthalmology, Gandhi Medical College, Bhopal, India, from August 2022 to June 2024 on preterm infants. Infants were examined in the retinopathy of prematurity (ROP) screening cubicle using aseptic precautions. All ocular findings were recorded on the proforma, and any abnormal findings were confirmed by the study guide. In cases where ROP is detected, fundus photo documentation is done. Counselling of the parents was conducted, emphasizing the importance of timely follow-up and the need for periodic reviews.

Results: The incidence of ROP was 24.9%, while the incidence of AROP was 10.5%. Overall, AROP was detected in 107 eyes of 56 patients. Zone I was most commonly involved in 58 eyes (54.2%), followed by posterior zone II in 49 eyes (45.8%). We documented a significant association of AROP with prolonged duration of stay in the neonatal intensive care unit (NICU) (18.20±10.21 vs. 13.17±6.35 days), oxygen supplementation of more than one week (87.5% vs. 68.4%), prolonged duration of oxygen supplementation (16.50±8.34 vs. 10.50±5.2), and ventilatory support of more than one week (16.1% vs. 3.9%; p<0.05). We found regression following treatment with anti-vascular endothelial growth factor (anti-VEGF) in significantly higher proportions of cases with zone I AROP and progression following anti-VEGF in cases with zone II posterior AROP (p<0.05).

Conclusions: The relatively high incidence of AROP, predominantly bilateral and affecting zone I, underscores the need for vigilant screening and early intervention in high-risk infants. Our findings reinforce the importance of minimizing exposure to supplemental oxygen and optimizing neonatal care practices to reduce the risk of AROP development and progression.

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