New and Unique Features of Aggressive Posterior Retinopathy of Prematurity
Jason M. So, MD; Irina Astasheva, MD; Alan B. Richards, MD; Graham E. Quinn, MD
Louisiana State University Health Sciences Center Shreveport
Shreveport, Louisiana, USA
Introduction: In 2005, IC-ROP introduced AP-ROP characterized based on the prominence of plus disease, faint neovascularization and posterior location. Today, AP-ROP remains difficult to diagnose early in its course. An epidemic of AP-ROP remains prevalent in premature infants in middle-income countries around the world, representing up to 30% of all Type 1 ROP cases. We report new photographic findings of AP-ROP to improve recognition of this disease.
Methods: Premature infants 1-6 months old (PCA 31-55 weeks) were examined in three large NICUs in Moscow between 2007 and 2016. Diagnosis of AP-ROP was made using indirect ophthalmoscopy and retinal pathology was documented using RetCam and B-scan ultrasonography.
Results: New and unique features of AP-ROP include: (1) retinal vessels appearing discontinuous or ‘broken’ due to retinal ‘edema’, making dilation and tortuosity less apparent; (2) dome-shaped elevation of the retina around the optic disc that spreads to involve the entire retina; (3) posterior shunt vessels; (4) large hemorrhages, even hemoglobus; (5) earlier onset; and (6) dilation of Cloquet’s canal.
Discussion: Features of AP-ROP may be different in middle-income countries due to neonatal care, where unrestricted oxygen may be given for weeks and delay in transport to level 3 NICUs is common. The picture of retinal ‘edema’ resembles findings in published the 1984 IC-ROP article. The cause of the retinal ‘edema’ is unclear; further investigation is needed.
Conclusion: Recognizing these new features allows for earlier diagnosis and treatment of AP-ROP. Early diagnosis is imperative to prevent infant blindness from this difficult-to-treat disorder.
References: 1. An International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity Revisited. Arch Ophthalmol. 2005; 123:991-999.
2. Quinn Graham E. et al. Retinopathy of Prematurity: An Epidemic in the Making. Chin. Med. J., Beijing 2010; 123:2929-2937.
3. Committee for the Classification of Retinopathy of Prematurity. An International Classification of Retinopathy of Prematurity. Arch Ophthalmol 1984; 102:1130-34.