Risk factors and timing of ocular complications after screening for retinopathy of prematurity.

PURPOSE: Retinopathy of prematurity (ROP) remains a leading cause of childhood vision loss, often resulting in long-term complications such as strabismus, amblyopia, and glaucoma. Despite advances in screening, limited data exist on which infants are at highest risk and when these complications typically emerge-an important gap given the nationwide shortage of pediatric ophthalmologists. This study aimed to identify predictors of post-ROP ocular complications and determine the optimal timing and frequency of pediatric ophthalmology follow-up visits. METHODS: We retrospectively reviewed 223 infants who underwent ROP screening between 2018 and 2021 and subsequently followed up with pediatric ophthalmology. The primary outcome was the development of ocular complications following ROP resolution, including their type and timing of detection. Univariate and multivariate logistic regression were used to identify independent risk factors, and Kaplan-Meier analysis assessed time to complication onset. RESULTS: Of 223 infants, 54 (24.2%) developed at least one ocular complication. The most common were refractive error (17.0%), strabismus (13.9%), and amblyopia (4.5%). Most complications occurred within two years after ROP clearance. Strabismus was diagnosed earliest, followed by refractive error and amblyopia. Longer NICU stay was an independent predictor of ocular complications (OR 1.30, 95% CI 1.04-1.63; p = 0.022). CONCLUSIONS: Nearly one in four infants developed ocular complications after ROP screening, typically within the first two years. NICU length of stay independently predicted risk, supporting the need for risk-stratified surveillance to ensure timely detection, optimize resource allocation, and reduce preventable vision loss in infants screened for ROP.