Aggressive posterior ROP appears to be more common among infants with comorbidities

Aggressive posterior ROP appears to be more common among infants with comorbidities

Pediatric Ophth/Strabismus, Retina/Vitreous

This retrospective analysis aimed to quantitatively characterize aggressive posterior retinopathy of prematurity (AP-ROP) in a large cohort.

Study design

The Imaging and Informatics in ROP cohort included 947 patients (5,945 clinical eye examinations with fundus images) from 8 North American centers. Pretreatment eyes were categorized by disease severity: none, mild, type 2 or pre-plus, and treatment-requiring with or without AP-ROP.


Infants with AP-ROP tended to be smaller by birth weight (617 g vs. 679 g), more premature (gestational age 24 weeks vs. 25 weeks), and reached peak severity at an earlier postmenstrual age (35 weeks vs. 37 weeks) compared with infants requiring treatment without AP-ROP. Many patients (80%) with AP-ROP had chronic lung disease. Individuals who required treatment with AP-ROP had a greater mean vascular severity score compared with those without (8.79 vs. 7.19). Quantitative evaluation of vascular severity using a deep learning-derived vascular severity score tracked with all categories of ROP including AP-ROP.


There is no good consensus on the diagnostic criteria for AP-ROP, making disease inclusion difficult. Even in this study, there was no agreement between experienced image graders. Since this study was conducted in North America, the data cannot be extrapolated to developing countries where the prevalence of AP-ROP is higher and the demographics are different.

Clinical significance

Aggressive posterior ROP is a rapidly progressive form of ROP that advances to stage 5 ROP quickly if not treated in a timely fashion. Premature infants in North America with AP-ROP are born younger, demonstrate disease earlier and have more chronic lung disease than infants with other categories of ROP.