Predictors of persistent avascular retina in retinopathy of prematurity treated with intravitreal ranibizumab.

PURPOSE: To identify predictive factors for persistent avascular retina (PAR) following primary intravitreal ranibizumab (IVR) monotherapy in retinopathy of prematurity (ROP).

METHODS

The medical records of 69 infants (128 eyes) with type 1 or aggressive ROP treated with IVR at a single center between July 2019 and March 2021 were reviewed retrospectively. Retinal vascular outgrowth speed (RVOS) was quantitatively assessed 2 months after IVR. Clinical parameters were evaluated, including birth weight, gestational age, cumulative clock hours of ROP lesions (ROP CCH), postmenstrual age (PMA) at IVR, ROP severity, and postnatal age (PNA) at IVR. Significant predictors from univariate analysis were incorporated into a multivariable logistic regression model presented as a nomogram.

RESULTS

The mean RVOS was 0.9 ± 0.6 disk diameters (DD)/month at 2 months post-IVR, with significantly faster vascular outgrowth in treated eyes compared to untreated fellow eyes (P < 0.05). Complete retinal vascularization was achieved in 69 eyes (53.9%) by 64 weeks PMA (±2 week), whereas PAR persisted in 59 eyes (46.1%). Multivariable analysis revealed four independent PAR predictors: slower RVOS (OR = 0.024 for faster RVOS), larger ROP CCH (OR = 2.263), later PNA at IVR (OR = 1.041), and advanced ROP severity (OR = 31.67). The developed nomogram showed excellent discrimination (AUC = 0.948) and calibration (P = 0.055).

CONCLUSIONS

Slower RVOS, advanced ROP severity, larger ROP CCH, and later PNA at IVR were independent PAR predictors. The nomogram reliably stratified risk for post-IVR management.