Incidence of Strabismus in Children with Retinopathy of Prematurity.

Abstract

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

Design: Retrospective cohort study.

Participants: Children aged ≤18 years with a diagnosis of ROP, with or without treatment exposure.

Methods: We defined treated ROP as receipt of laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (VEGF) injection, while 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 (CIs), adjusting for demographic variables and ocular comorbidities.

Main outcome measures: 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 to 1.95; P < 0.001). Amblyopia (aHR, 2.58; 95% CI, 2.25-2.96; P < 0.001) and nystagmus (aHR, 1.76; 95% CI, 1.48-2.1; P < 0.001) were also independently associated with increased hazard.

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