Management of Persistent Avascular Retina in Retinopathy of Prematurity: An International Survey.

BACKGROUND AND OBJECTIVE: Indications for laser photocoagulation of persistent avascular retina (PAR) in retinopathy of prematurity (ROP) remain controversial. This study aimed to characterize current clinical practice patterns to inform future studies addressing these discrepancies. PATIENTS AND METHODS: A cross-sectional REDCap (Research Electronic Data Capture) survey was conducted, distributed primarily via email to vitreoretinal and pediatric ophthalmology fellowship directors. Responses from 106 ROP specialists across six continents were analyzed. The primary outcome was the proportion of respondents recommending laser treatment for PAR following spontaneous ROP regression or intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. RESULTS: Most respondents had completed vitreo-retinal (57%) or pediatric (42%) ophthalmology fellowship training, with many (84%) based in North America. Anti-VEGF was preferred by 80% of respondents as primary ROP treatment for the majority of patients. Laser was more frequently considered for zone II (69%) than zone III (58%) PAR, particularly following anti-VEGF therapy. Following post-anti-VEGF reactivation, laser was recommended in the majority of cases (59%). In spontaneously regressed ROP, 50% of respondents did not routinely recommend laser. CONCLUSION: Practice patterns for PAR management vary, with greater support for laser in zone II disease and after anti-VEGF therapy.