Incidence and treatment outcomes of retinopathy of prematurity in preterm infants assessed through wide-field fundus imaging: a retrospective cohort study.

Background: Retinopathy of prematurity (ROP), a leading cause of childhood blindness globally, disproportionately affects preterm/low-birth-weight infants. This study aims to evaluate the incidence and therapeutic outcomes of ROP using wide-field fundus imaging in this high-risk cohort. Methods: A total of 300 preterm or low-birth-weight infants (gestational age <32 weeks or birth weight <2,000 g) admitted between November 2022 and March 2024 were consecutively enrolled. Retinal screening was conducted using a wide-field fundus imaging system, when infants survived for 28 days or longer. Clinical data, including the timing of screening, maternal and perinatal history, and retinal findings, were systematically documented. Classification standards were followed the International Classification of Retinopathy of Prematurity. Infants who met the criteria for threshold ROP received intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy and were monitored over time to evaluate their response to treatment. Spearman correlation analysis was used to assess associations between ROP incidence and potential risk factors. A value of P<0.05 was considered statistically significant. Results: ROP was diagnosed in 37 infants (incidence: 12.33%), distributed as follows: two cases in zone I, 17 in zone II, and 18 in zone III. "Plus" disease was identified in nine infants. All nine infants with threshold disease received anti-VEGF therapy; one case exhibited recurrence and required a second injection, after which regression of lesions was observed. A statistically significant inverse correlation was observed between ROP incidence and both birth weight and gestational age (Z=-8.500, -8.610; P<0.001). Similarly, a negative correlation was noted between the occurrence of ROP and these parameters (R=-0.499 and -0.490; P<0.001). Infants with threshold ROP had significantly lower birth weights and gestational ages compared to those without threshold disease (Z=-5.002, -4.990; P<0.001), and the development of threshold ROP demonstrated a negative correlation with gestational age and birth weight (R=-0.338 and -0.341; P=0.020 and 0.019, respectively). ROP lesions generally manifested around six weeks postnatally, with treatment typically administered at approximately eight weeks. Conclusions: Wide-field fundus imaging serves as an effective modality for the screening of ROP in preterm infants. Screening is optimally initiated at approximately six weeks after birth, particularly for infants with lower birth weight and gestational age, as they are at an increased risk. Anti-VEGF therapy demonstrates favorable outcomes in the management of threshold ROP.