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H.D. Lam, K.A. Tawansy, M.A. Samuel, H. Lee; DELAYED RETINAL VASCULAR MATURATION AND LATE ONSET MACULAR DRAGGING AND RETINAL DETACHMENT IN NEONATES WITH RETINOPATHY OF PREMATURITY . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4027.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe clinical features of an atypical form of ROP in which macular dragging or retinal detachment was detected on close follow up after 45 weeks post–conceptual age in the absence of pre–threshold disease or traditional high–risk signs. Methods: Retrospective review of clinical cases referred to a major center specializing in surgical therapy of ROP. Mode of presentation, age at retinal detachment, and fundus manifestations were studied. Results: Of 77 consecutive patients with acute ROP detachments stages 4 and 5 seen over an 18 month interval, six had detachments first observed to occur between 46 and 57 weeks post conception. Of 20 patients with macular dragging seen over the same time period, five developed this change between 45 and 55 weeks post conception. None of these patients developed plus disease or pre–threshold features before the onset of retinal dragging or detachment. All patients had evidence of one or more circumferential fibrotic ridges in zones 2 and 3, often concentric and suggesting a stuttering pattern of retinal vascular development. None of the patients had plus disease, angry neovascularization, or heavy leakage on fluorescein angiography at the time of intervention. All were treated with laser ablation of the remaining avascular retina with or without scleral buckle or vitrectomy, which resulted in stabilization or improvement in retinal anatomy Systemic factors which may be associated with this type of ROP include extremely low birth weight, early hydrocephalus or intraventricular hemorrhage, and bone marrow hypoplasia. Conclusions: Significant macular dragging or retinal detachment may occur in neonates with incomplete retinal vascular development beyond 45 post conceptual age and in the absence of pre–threshold signs. Despite findings of recent major studies, our experience sugggests that follow up exams may be continued beyond 45 weeks of post–conceptual age and until retinal vascular development reaches the ora serrata in all quadrants.
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