Aggressive posterior retinopathy of prematurity: risk factors for retinal detachment despite confluent laser photocoagulation.

PURPOSE

To analyze risk factors for retinal detachment in eyes with aggressive posterior retinopathy of prematurity (ROP) treated with confluent laser photocoagulation.

DESIGN

Retrospective, consecutive, interventional case series.

METHODS

Infants undergoing laser treatment for aggressive posterior ROP from January 2006 through June 2010 participated. Eyes with retinal detachment (stage 4A, 4B, and 5) at presentation and those lost to follow-up after treatments were excluded. We defined 2 groups based on outcome after confluent laser photocoagulation: retinal detachment or favorable outcome. Two groups were compared for various factors, which included birth weight, gestational age, postconceptional age at laser treatment, zone of disease, preretinal hemorrhage, pre-existing fibrovascular proliferation, tunica vasculosa lentis, laser spots used for primary treatment, need for repeat laser treatment, and new-onset fibrovascular proliferation after laser treatment. Data were analyzed using univariate and multivariate logistic regression analysis.

RESULTS

One hundred nineteen eyes of 61 infants underwent laser treatment for aggressive posterior ROP. Ten (8.4%) eyes were excluded and 109 eyes (91.6%) were included. Nineteen (17.4%) of 109 eyes progressed to retinal detachment after laser treatment. On univariate analysis, multiple factors were associated with retinal detachment. Of these, all eyes with posterior zone 1 disease and all eyes demonstrating extensive fibrovascular proliferation (> 3 clock hours) after laser treatment progressed to retinal detachment. On multivariate logistic regression analysis, the most significant predictors of retinal detachment were gestational age of less than 29.5 weeks (P = .006), hemorrhages (P = .003), need for repeat laser treatment (P = .006), and new-onset limited fibrovascular traction (< 3 clock hours) after laser treatment (P = .042).

CONCLUSIONS

A gestational age of less than 29.5 weeks, posterior zone 1 disease, and preretinal hemorrhages before laser treatment are the most significant risk factors for retinal detachment in aggressive posterior ROP. Of the events occurring after laser treatment, new-onset fibrovascular traction is associated significantly with development of retinal detachment.