Korean J Ophthalmol.  2013 Apr;27(2):109-115. 10.3341/kjo.2013.27.2.109.

Capillary-free Vascularized Retina in Patients with Aggressive Posterior Retinopathy of Prematurity and Late Retinal Capillary Formation

• Ahn SJ
• Kim JH
• Kim SJ
• Yu YS

• KMID: 1503802
• DOI: http://doi.org/10.3341/kjo.2013.27.2.109

Abstract

PURPOSE
To report the clinical features, clinical course, and treatment outcomes after laser photocoagulation in infants with aggressive posterior retinopathy of prematurity (APROP) and capillary-free zones in vascularized retina.
METHODS
Six patients (12 eyes) with APROP and capillary-free zones in vascularized retina were retrospectively reviewed. Twelve eyes of six infants were included and were treated with laser photocoagulation for avascular retina and for capillary-free zones in vascularized retina, except for the posterior pole, and fundus findings were photographically-documented in sequence. In addition, anatomic and visual outcomes were evaluated with complications of APROP.
RESULTS
Among all of the consecutive infants with APROP, capillary-free zones in vascularized retina were demonstrated in 24% of the infants. All of the infants were >27 weeks of gestation age and had birth weights >1,000 g. After laser treatment, 7 eyes (58.3%) had favorable outcomes, and late capillary filling in capillary-free zones of vascularized retina were noted, however 4 eyes (33.3%) progressed to retinal detachment and 1 eye (8.3%) was complicated by a retinal fold-distorting posterior pole. The visual outcomes were associated with anatomic outcomes.
CONCLUSIONS
The anatomic outcomes in infants with APROP who had capillary-free zones were comparable to previously reported infants with APROP. The late capillary filling of capillary-free zones in vascularized retina was noted, and angiogenesis was considered to be involved. This process toward normal capillary formation or neovascularization in APROP, might determine its outcome.

Keyword

Aggressive posterior retinopathy of prematurity; Angiogenesis; Capillaries

MeSH Terms

Capillaries/*pathology
Female
Humans
Infant
Laser Coagulation/*methods
Male
Retina/*pathology/surgery
Retinal Vessels/*pathology/surgery
Retinopathy of Prematurity/*pathology/*surgery
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Fundus photographs of patients with aggressive posterior retinopathy of prematurity revealing capillary-free zones in vascularized retina. (A,B) The infants demonstrated multiple capillary-free zones (black arrow) surrounded by retinal vasculature or retina with capillary formation. In addition, a prominent plus sign and pre-retinal hemorrhage (white arrow) were revealed. (C,D) A more highly magnified view revealing a capillary free-zone (black arrow) within vascularized retina in contrast to the area with capillary formation denoted by an arrowhead.

• 

  Fig. 2 Short-term course of a capillary-free zone in patient 2, who had a favorable outcome. (A-D) Serial follow-up after laser treatment (A, 10 days; B, 2 weeks; C, 4 weeks; and D, 5 weeks after the laser treatment). The capillary-free zone (bordered by black arrows) and pre-retinal hemorrhage gradually decreased after the laser treatment and resolved as shown in (D) together with regression of the plus sign.

• 

  Fig. 3 Long-term clinical course of capillary-free zones demonstrated in the right eye of patient 5 (A) before laser treatment and (B) on the day of laser treatment (post-treatment). Black arrows denote capillary-free zones in vascularized retinas, in contrast to retinas with capillary formation (arrowhead). White arrows demonstrate retinal vessels, and thus the space enclosed by them indicates a vascularized zone. (C) Seven months later, capillary formation was achieved but a focal fibrous membrane was noted along the superior arcade and at the last visit, at 15 months after laser treatment, RetCam image in (D) shows a stable fibrous membrane without tractional retinal detachment, otherwise the fundus is normal.

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