Incidence and Risk Factors for Persistent Avascular Retina in Patients with a History of Retinopathy of Prematurity in Mexico

Background/Objectives: To determine the incidence of persistent avascular retina (PAR) and identify associated risk factors in patients with a history of retinopathy of prematurity (ROP) evaluated with ultra-widefield imaging. Methods: A retrospective case–control study was conducted on patients with a history of ROP evaluated with ultra-widefield imaging at a tertiary care center in Mexico. Clinical variables were analyzed, with PAR as the primary outcome. Associations were assessed using binary logistic regression models. Results: Ninety-two patients were included, of whom 12 (13.0%) presented with PAR. Receiving ≥2 anti-VEGF injections was significantly associated with PAR (OR 4.48; 95% CI 1.21–16.64; p = 0.032), an association that remained consistent after adjustment for gestational age and maternal factors. Additionally, maternal preeclampsia and chorioamnionitis were independently associated with PAR. Conclusions: Persistent avascular retina appears to result from a complex interplay of prenatal and postnatal factors affecting retinal vascular development. Patients requiring repeated anti-VEGF treatment and those exposed to adverse maternal conditions may represent a subgroup at increased risk for incomplete peripheral retinal vascularization, supporting the need for long-term retinal surveillance after ROP regression.