Persistent avascular retina in eyes with retinopathy of prematurity: A comprehensive review.

Abstract

Persistent avascular retina (PAR) refers to retinal areas where vascular development permanently arrests in premature children. In the last decade, the first-line treatment for retinopathy of prematurity (ROP) has shifted from laser photocoagulation to antivascular endothelial growth factor (VEGF) therapy, leading to the increased observation of PAR in eyes treated for ROP. Emerging evidence suggests that PAR could pose a risk for late reactivation of ROP, retinal breaks, or detachment. Consequently, PAR has emerged as an important finding in eyes of regressed ROP. In this review, we summarize the recent understanding of PAR, including its pathophysiologic mechanism, prevalence, clinical pathological significance, and management. We conclude that PAR can be often observed in eyes treated with anti-VEGF therapy (type 1 ROP) and in those that regress without treatment (type 2 ROP). Current management of PAR lacks consensus; however, since PAR can potentially cause late reactivation or rhegmatogenous retinal detachment after achieving regression of ROP, treatment with laser photocoagulation should be considered, and lifelong monitoring is recommended.