Abstract Objectives To investigate the impact of intrauterine pathologies, including twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR), on the development of retinopathy of prematurity (ROP) in monochorionic diamniotic (MCDA) twins and to establish risk prediction models. Methods A retrospective case-control study was conducted including 466 MCDA preterm twins born before 37 weeks. Participants were categorized into three groups (TTTS, sIUGR, and uncomplicated). Clinical and laboratory data were analyzed. Significant predictors were identified via random forest algorithm and multivariate logistic regression. ROC and DCA analyses were used to evaluate predictive models. Results ROP incidence was significantly higher in the TTTS group (37.8 %) compared with sIUGR (8.2 %) and uncomplicated twins (10.7 %) (p<0.0125). TTTS was confirmed as an independent risk factor (OR=2.846, p<0.05). Gestational age was the strongest predictor. Four risk models showed AUCs of 0.796–0.919. The risk of ROP onset increases significantly in MCDA twin preterm infants from a birth gestational age of 30 weeks (TTTS group), 31.3 weeks (sIUGR group), and 32 weeks (uncomplicated group); infants with these birth gestational ages are a high-risk population for ROP. Conclusions TTTS significantly elevates ROP risk in MCDA twins. Personalized screening protocols based on intrauterine pathology may improve ROP detection and outcomes.
Zhao et al. (Fri,) studied this question.