{"doi":"10.1016/j.ophtha.2023.09.032","title":"Imaging Features Associated with Persistent Avascular Retina in Retinopathy of Prematurity","abstract":"The use of anti-VEGF therapy as the primary treatment for retinopathy of prematurity (ROP) has generated attention to the potential for long-term avascularity of the peripheral retina after initial treatment. The most recent International Classification of Retinopathy of Prematurity, Third Edition, formally termed this finding “persistent avascular retina” (PAR) and recognized that it can occur after spontaneous regression or anti-VEGF treatment.1Chiang M.F. Quinn G.E. Fielder A.R. et al.International Classification of Retinopathy of Prematurity, Third Edition.Ophthalmology. 2021; 128: e51-e68Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar A potential benefit of anti-VEGF primary treatment compared with laser is increased vascularized area, potentially enlarging the functional visual field long term. However, this treatment also has the potential to reactivate and cause atypical ROP-related retinal detachments in infancy, as well as increasing the long-term risk of detachment.2Hu J. Blair M.P. Shapiro M.J. et al.Reactivation of retinopathy of prematurity after bevacizumab injection.Arch Ophthalmol. 2012; 130: 1000-1006Crossref PubMed Scopus (238) Google Scholar A better understanding of which babies are at highest risk of PAR could help risk stratify who would benefit most from more frequent examinations and possibly laser. Recent work has demonstrated that a higher vascular severity score (VSS), derived from the artificial intelligence–based Imaging and Informatics in ROP deep learning algorithm, is associated with more posterior disease, higher disease stage and extent, and higher risk of treatment failure with laser.3Gupta K. Campbell J.P. Taylor S. et al.A quantitative severity scale for retinopathy of prematurity using deep learning to monitor disease regression after treatment.JAMA Ophthalmol. 2019; 137: 1029-1036Crossref PubMed Scopus (50) Google Scholar In this report, we evaluate whether imaging-based quantitative metrics such as the VSS or the measured posterior extent of retinal vascularization at the time of treatment with intravitreal bevacizumab (IVB) may be associated with disease reactivation or failure to fully vascularize (PAR). We performed a retrospective consecutive case series of 66 eyes from 33 infants with type 1 ROP. This study was performed in accordance with the Health Insurance Portability and Accountability Act of 1996 and respected the tenets of the Declaration of Helsinki. Institutional Review Board Ethics Committee approval was obtained from the University of California, San Diego, and Rady Children’s Hospital. Informed consent was not required for this retrospective study. Demographic details are summarized in Table S1 (available at www.aaojournal.org). Retinal fundus images were acquired via a RetCam (Natus) or the Panocam (Visunex Medical Systems). Treatment and re-treatment decisions were determined via single-provider clinical examination (E.N.); re-treatment was recommended if there was reactivation of neovascularization or worsening plus disease or if vascular growth failed to reach zone III by 50 weeks postmenstrual age (PMA). The extent of retinal vascularization and rate of vascular growth after IVB (0.625 mg) were measured (H.R-H., E.N.). Briefly, the mean of 5 measurements—taken from the center of the optic disc, through the macula, to the anterior edge of the ridge—was calculated from retinal fundus images using ImageJ (https://imagej.nih.gov) (Fig S1, available at www.aaojournal.org). Measurements were converted from pixels to millimeters using a standardized pixel conversion calculator (https://pixelcalculator.com/en). Eye-level VSS at the time of IVB and laser (if applicable) treatment was calculated using the Imaging and Informatics in ROP DL system.4Campbell J.P. Singh P. Redd T.K. et al.Applications of artificial intelligence for retinopathy of prematurity screening.Pediatrics. 2021; 147e2020016618Crossref Google Scholar,5Chen T.A. Shields R.A. Bodnar Z.H. ","journal":"Ophthalmology","year":2023,"id":350192,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9534,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":336863,"name":"Aaron S. Coyner","orcid":"0000-0003-3261-1909","position":1,"is_corresponding":false},{"id":264208,"name":"J. Peter Campbell","orcid":"0000-0001-7964-9475","position":2,"is_corresponding":false},{"id":706472,"name":"Eric Nudleman","orcid":"0000-0002-9467-1563","position":3,"is_corresponding":false},{"id":783046,"name":"Hailey Robles-Holmes","orcid":null,"position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-19T01:12:23.769679Z","pmid":"37805003","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}