Incidence of Strabismus in Children With Retinopathy of Prematurity.

Abstract

To estimate the cumulative incidence of strabismus among children diagnosed with retinopathy of prematurity (ROP). Retrospective cohort study. Participants were children and adolescents aged ≤18 years with a diagnosis of ROP, with or without treatment exposure. We defined treated ROP as receipt of laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, whereas untreated ROP had no record of either intervention. We estimated the cumulative incidence of strabismus at 1, 3, and 5 years after ROP diagnosis using Kaplan-Meier analysis. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for demographic variables and ocular comorbidities. The main outcome measure was development of strabismus following ROP diagnosis. The cohort included 27,720 ROP patients: 973 were treated, and 26,747 were untreated. cumulative incidence of strabismus was consistently higher among treated patients. At 5 years, cumulative incidence was 34.78% in treated patients compared with 22.14% in untreated patients, with esodeviations as the most common subtype, occurring in 22.35% of treated patients and 11.87% of untreated patients. Treatment exposure was independently associated with an increased hazard of strabismus (aHR = 1.58; 95% CI = 1.29-1.95; P < .001). Amblyopia (aHR = 2.58; 95% CI = 2.25-2.96; P < .001) and nystagmus (aHR = 1.76; 95% CI = 1.48-2.10; P < .001) were also independently associated with increased hazard. ROP confers an increased hazard of developing subsequent strabismus, with higher cumulative incidence among children who underwent treatment for ROP.