Retinopathy of Prematurity in the Gray Zone of Classification: Etiologic Factors and Long-term Clinical Investigation

Abstract BackgroundThis study aimed to evaluate peripheral vascular and retinal findings in school-aged children with a history of zone 2 stage 2 retinopathy of prematurity (ROP) without plus disease. The second aim of the study was to investigate possible risk factors for persistent avascular retina (PAR) in this group.MethodsThe study patients were divided into two groups: those with completed vascularization (Group CV) and those with a PAR (Group PAR). The maternal and neonatal risk factors for PAR were assessed. Fluorescein angiography (FA) images and clinical examination findings were evaluated for both groups.ResultsOf the 80 patients whose data were reviewed, 32 were included in the CV group, and 18 were included in the PAR group. Group PAR had a significantly longer duration of systemic antibiotic therapy (p = 0.032). The risk of PAR was increased in patients with the most severe stage of ROP diagnosed at ≥ 37 weeks and later and in patients with late discharge (OR = 12.458, p = 0.008, OR = 1.045, p = 0.016). The most common FA finding in both groups was abnormal branching (p = 0.628).ConclusionsZone 2 stage 2 ROP without plus disease is not included in the classification of ROP; however, it is a group that requires close monitoring due to the risk of progression to type 1 or type 2 ROP during the neonatal period and the risk of retinal complications that may develop secondary to PAR in the future. Although there is insufficient evidence to support prophylactic treatment, regular peripheral retinal examinations are recommended for children with PAR.