Incidence of Strabismus in Children With Retinopathy of Prematurity.

PURPOSE: To estimate the cumulative incidence of strabismus among children diagnosed with retinopathy of prematurity (ROP).

DESIGN: Retrospective cohort study.

METHODS: Participants were children and adolescents aged ≤18 years with a diagnosis of ROP, with or without treatment exposure. We defined treated ROP as receipt of laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, whereas untreated ROP had no record of either intervention. We estimated the cumulative incidence of strabismus at 1, 3, and 5 years after ROP diagnosis using Kaplan-Meier analysis. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for demographic variables and ocular comorbidities. The main outcome measure was development of strabismus following ROP diagnosis.

RESULTS: The cohort included 27,720 ROP patients: 973 were treated, and 26,747 were untreated. cumulative incidence of strabismus was consistently higher among treated patients. At 5 years, cumulative incidence was 34.78% in treated patients compared with 22.14% in untreated patients, with esodeviations as the most common subtype, occurring in 22.35% of treated patients and 11.87% of untreated patients. Treatment exposure was independently associated with an increased hazard of strabismus (aHR = 1.58; 95% CI = 1.29-1.95; P < .001). Amblyopia (aHR = 2.58; 95% CI = 2.25-2.96; P < .001) and nystagmus (aHR = 1.76; 95% CI = 1.48-2.10; P < .001) were also independently associated with increased hazard.

CONCLUSIONS: ROP confers an increased hazard of developing subsequent strabismus, with higher cumulative incidence among children who underwent treatment for ROP.