Retinopathy of Prematurity in the Extremely Premature: Disease Burden, Treatment Approaches, and Visual Outcomes in Micro- and Nano-Premature Infants.

Abstract

To characterize the treatment and outcomes of retinopathy of prematurity (ROP) in high-risk extremely premature infants. Retrospective, single-center clinical cohort study. Infants meeting criteria for micro-prematurity (24-26 weeks gestational age [GA] and/or birth weight [BW] 600-799 grams) or nano-prematurity (<24 weeks GA and/or BW <600 grams) from 2013 to 2023 were included. Total 3239 infants were screened, of which 702 infants were included and 525 infants were selected for analysis after excluding patients lost to follow-up ROP was observed 891 eyes (84.9%)225 eyes (21.4%) developed type 1 disease and required treatment. with laser and/or anti-VEGF. One hundred and thirty two eyes of 74 patients (12.6%) required re-treatment. Lower GA, lower BW, and central nervous system hemorrhagic injury were associated with treatment-warranted ROP on multivariable regression. The nano-premature demonstrated more severe ROP, more posterior disease, higher rates of treatment at earlier ages, increased incidence of treatment by all modalities, higher rates of amblyopia, worse final visual acuity, and more frequent developmental delay. While treatment can stabilize the disease, patients face ongoing challenges, including visual and developmental complications. Lower GA, lower BW, and central nervous system injury emerged as significant risk factors for treatment-warranted ROP. Nano-premature infants showed higher rates of more severe ROP, amblyopia, and poorer visual outcomes compared to micro-premature infants. These findings highlight the importance of screening and follow-up in this population and provide valuable natural history, treatment, and outcome information for ophthalmologists caring for these high-risk infants.