311 - Earlier Treatment Requirement Is Associated With a More Severe Course in Retinopathy of Prematurity

Publication Number: 4305.311

Toshihiko Manabe, University of Occupational and Environmental Health, Japan, Kitakyushu-shi, Fukuoka, Japan; Shutaro Suga, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan; HIKARU TAKAHASHI, University of Occupational and Environmental Health,Japan, Kitakyushu-shi, Fukuoka, Japan; Reiji Fukano, Department of Pediatrics, University of Occupational and Environmental Health, Japan, KitaKyushu, Fukuoka, Japan

Background: Retinopathy of prematurity (ROP) is a multifactorial disease. Prior studies have identified several risk factors for treatment-requiring ROP, including extreme prematurity, blood transfusion, prolonged mechanical ventilation, and delayed enteral nutrition. However, few studies have specifically examined the clinical characteristics and risk factors of advanced ROP (Stage 4A,4B,5), which require vitrectomy and are associated with a high risk of irreversible visual impairment.

Objective: We aimed to investigate the clinical characteristics and risk factors of advanced-stage ROP requiring vitrectomy.

Design/Methods: We conducted a retrospective cohort study of infants admitted to the NICU at our Hospital from January 1, 2012, to December 31, 2022. Infants born at < 32 weeks' gestation and/or with a birth weight < 1500 g were eligible if diagnosed with Stage ≥2 ROP in at least one eye (Figure 1). Infants with aggressive posterior ROP and those with non-treatment-requiring ROP were excluded. Eligible infants were categorized based on the most advanced ROP stage: treatment-requiring ROP (Stage 2,3) and advanced ROP (Stage 4A-5). Clinical characteristics were compared, and multivariate logistic regression was performed to identify independent risk factors for progression to advanced ROP. As a tertiary referral center serving a wide catchment area, our cohort may include a higher proportion of severe cases.

Results: Of 119 infants with Stage ≥2 ROP, 41 had Stage 2-3 ROP and 42 had advanced ROP. Baseline characteristics were similar between groups, except for treatment timing. Infants who developed advanced ROP underwent initial treatment significantly earlier than those with Stage 2-3 disease (median 57 vs. 77 days, P < 0.001) (Table 1). Treatment patterns varied by severity (Table 2). Stage 2-3 cases were no vitrectomy required. In Stage 4A, all patients underwent laser therapy, over half received anti-VEGF, and most progressed to vitrectomy. In Stage 4B-5, nearly all patients ultimately required vitrectomy despite prior laser and/or anti-VEGF treatment.Multivariate logistic regression identified postnatal age at initial treatment < 60 days as an independent risk factor for advanced ROP (adjusted odds ratio 6.16; 95% CI, 2.13-20.3; P < 0.001) (Table 3). Other factors were not significantly associated with advanced disease.

Conclusion(s): Earlier treatment requirement was independently associated with progression to advanced ROP. This suggests that infants who require treatment at an earlier postnatal age may have a more aggressive disease trajectory, warranting intensified surveillance and timely intervention.

Flowchart of Patient Inclusion and Classification According to ROP Stage and Treatment Requirements


Perinatal and Neonatal Characteristics of Infants with Treatment-Requiring ROP (Stage 2-3) and Advanced ROP (Stage 4-5)


Table 2. Distribution of Treatment Modalities Across ROP Stage, Table 3. Multivariable Logistic Regression Analysis for Risk Factors Associated With Advanced ROP