Patients with Regressed ROP Still at Risk of RD By Age 30

Despite the challenges of poor vision and high prevalence of macula-off RDs, surgical intervention can still offer significant benefits for patients with RRD. By contrast, patients with tractional retinal detachment (seen here) often require multiple surgeries. Photo: Jessica Haynes, OD. Click image to enlarge. Individuals with a history of retinopathy of prematurity (ROP) have been reported to exhibit a higher incidence of various ocular disorders. Several late-onset vitreoretinal complications may manifest even years after ROP regression. Among these, retinal detachment (RD) stands out as the most vision-threatening but potentially preventable. In a recent study published in American Journal of Ophthalmology, a team of researchers investigated the clinical features, surgical outcomes, and prognostic determinants of late vitreoretinal complications in patients with regressed ROP, with or without prior treatment, encompassing both rhegmatogenous RD (RRD) or tractional RD (TRD). They found that RRD (94.9%) predominated the study cohort and generally achieved favorable surgical outcomes, although large retinal breaks and prior acute-phase ROP surgery predicted poorer prognosis. TRD (5.1%) presented earlier, often required multiple surgeries, and demonstrated inferior anatomic success.“Given the elevated lifetime risk, particularly before age 30, regular ophthalmic examinations are recommended for early detection and timely intervention,” the study authors wrote in their paper.The researchers analyzed 177 eyes from 156 patients, with a mean age at presentation of 20.3. Among the patients, 41.7% were Caucasian, 30.8% were Asian, 15.4% were Black, 6.4% were Hispanic and one (0.6%) was Indian; the race/ethnicity of the remaining eight (5.1%) was unknown. Of these eyes, 168 belonged to 148 patients with RRD, whereas the remaining nine eyes were from eight patients with TRD. The average age of presentation was 17.0 and 20.5 in TRD and RRD, respectively. Presenting best-corrected VA was 1.6 logMAR equivalent and 1.5 logMAR equivalent for RRD and TRD, respectively. For advice on how to better recognize retinal tears, see this feature. RRD showed a significant VA improvement postoperatively. In contrast, TRD had a higher percentage of multiple surgeries (77.8%) and a significantly poorer final reattachment rate (66.7%). Poor anatomic outcomes in RRD were linked to break sizes greater than 1.5mm and prior acute-stage surgery for ROP.In the study cohort, all TRDs with a known stage were type I ROP, compared to 24 out of 32 cases of type I ROP in the RRD group. The research team hypothesized that patients with a history of severe ROP may experience an early reactivation of aborted proliferation, premature vitreous syneresis, and stretching of regressed fibrovascular tissue, resulting in TRD. Conversely, those with less severe ROP may develop persistent avascular retina, leading to the formation of atrophic holes, which, when combined with an elongated axial length and liquefied vitreous over time, may contribute to the development of RRD.“These complications may manifest at various ages, ranging from the first to the sixth decade, with a predominant occurrence before the age of 30 years,” the researchers noted. “A higher likelihood of unfavorable surgical outcomes in cases of prior surgical treatment for ROP and a larger break size should be acknowledged and communicated to patients in advance.” Click here for the journal source. Hsu HT, Kang EYC, Blair MP, et al. Comparing rhegmatogenous and tractional retinal detachment in regressed retinopathy of prematurity: an international, multicenter study. Am J Ophthalmol. October 22, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.