Reactivation of Retinopathy of Prematurity in Adults and Adolescents

Purpose: To review the clinical features, treatment outcomes, and prevalence within our clinic population of adolescents and adults with previously regressed retinopathy of prematurity (ROP) who demonstrate late-onset exudation and vasoproliferative changes. Design: Retrospective review of consecutive patients at a single center. Participants: Five patients (5 eyes) with a history of ROP who showed new exudates or worsening fibrovascular proliferation diagnosed after 10 years of age. Methods: Patients were identified by a computerized search of the Emory Eye Center billing records. Data extracted from charts included baseline ROP information, visual acuity and other examination findings, imaging, and treatments. Main Outcome Measures: Status of exudation and vasoproliferation. Results: Among 138 patients older than 10 years with ROP seen at our tertiary referral center from 2000 through 2018, 5 (3.6%) demonstrated late-onset exudation or vasoproliferation. Three patients were female and 3 underwent ROP treatment as neonates. Mean age at onset of late reactivation was 25.6 years (range, 13–43 years). Previous treatments for neonatal ROP included peripheral laser ablation (n = 3), scleral buckle (n = 2), pars plicata vitrectomy (n = 2), and no treatment (n = 2). Management strategies for late reactivation included observation (n = 1), intravitreal anti–vascular endothelial growth factor agents (n = 4), vitrectomy (n = 2), and cryotherapy (n = 1). With mean follow-up of 4.8 years (range, 1–7 years), outcomes were resolution of exudation or proliferation with return to baseline vision (n = 2), stable mild exudation (n = 1), and progressive vasoproliferation with traction leading to phthisis (n = 2). Conclusions: Late-onset exudation and fibrovascular proliferation in adolescents and adults with ROP can occur rarely with previously regressed ROP. Two of 5 patients were refractory to all treatments and demonstrated phthisis bulbi. One patient showed reactivation in the form of a reactive retinal astrocytic tumor. Our findings highlight the importance continued monitoring with regular fundus examination in adolescents and adults with regressed ROP.