Aggressive Posterior Retinopathy of Prematurity in Asian Indian babies Weighing ≥1500 Grams at Birth

Mohit Dogra

Purpose:To study the spectrum of aggressive posterior retinopathy of prematurity (APROP) in infants ≥ 1500 gm birth weight.

Methods A retrospective review of infants ≥1500 g birth weight and treated for APROP at a tertiary centre

Results: Twenty-seven eyes of 14 infants are included.The mean birth weight and gestational age were 1797.79± 291.32 g and 30.6 ± 1.00 weeks respectively. All infants were referred from level I or II accredited nurseries. The predominant systemic co-morbidities included unmonitored oxygen supplementation in 100%, sepsis in 57.1 % and respiratory distress syndrome in 57.1 % infants .Of the 27 eyes, 10(37%) had zone 1 and 17(63 %) had post zone 2 disease .Twenty-five (92.6%) eyes had flat neovascular syncytium while 2(7.4 %) eyes had brush like proliferation with stage 4a ROP. Additional atypical features were noticed in 14(51.8%) eyes. This included large vascular loops in six (22.2%) eyes, intervening ridge tissue in four (14.8%) eyes and both in four (14.8%) eyes. All eyes underwent confluent laser treatment at a mean post conceptional age of 35.07±1.52 weeks .Eyes treated at 4a had an unfavorable outcome. Of the twenty-five eyes treated early, 20 (80%) eyes had a favorable outcome. Remaining 5(20%) eyes had an unfavorable outcome (Stage 4a:1 eye, residual proliferation:1 eye,Cataract;2 eyes, vitreous hemorrhage :One eye).

Conclusion: Infants ≥ 1500 gm birth weight may develop APROP in a developing country due to unmonitored supplemental oxygen and multiple systemic co-morbidities. With early confluent laser, 80% eyes had a favorable outcome