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Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness in preterm infants. This study presents a ten-year retrospective analysis of ROP incidence, severity, and treatment outcomes at a tertiary neonatal unit in London.All infants born at <31 weeks’ gestation or with a birth weight <1501g between January 1, 2015, and December 31, 2024, were included (n = 464). ROP screening was performed in accordance with national guidelines. A detailed subset of 73 infants with complete ophthalmologic records was analysed for disease severity, treatment modalities, and associated clinical factors.Of the total cohort, 50 infants (10.7%) required treatment for ROP. Among the 73 infants in the detailed cohort, 68.4% were inborn and 31.5% were transferred from other hospitals. Advanced ROP (Stage ≥3) was observed in 75.3% of treated infants. The mean gestational age at birth was 24 weeks. Notably, 61.6% received a complete antenatal steroid course, while 56.1% required postnatal steroids. The mean durations for parenteral nutrition, invasive ventilation, and total ventilation (invasive + non-invasive) were 45, 54, and 72 days respectively. Surgical necrotizing enterocolitis occurred in 31.5% of cases, and chorioamnionitis was noted in 5.4%. The mean corrected gestational age at Threshold ROP diagnosis was 36 weeks.All ROP cases received treatment: 78% with laser photocoagulation alone, 16.4% with intravitreal Avastin, and 4.1% with Lucentis. One case received combination therapy. Four infants (5.4%) required referral for vitrectomy.The incidence of treatment-requiring ROP was 10.7% over the ten-year period. Most affected infants presented with severe disease. These findings underscore the importance of early screening and timely intervention in high-risk neonatal populations to prevent vision loss.