ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Evaluation of aggressive posterior retinopathy of prematurity (AP-ROP) in the German Retina.net ROP registry
Marie-Christine Bründer 1
Johanna Madeleine Pfeil 1
Marlene Sassmannshausen 2
Navid Farassat 3
Birgit Lorenz 4
Lyubomyr Lytvynchuk 4
Helge Breuss 5
Teresa Barth 6
Christos Skevas 7
Hufendiek Karsten 8
Tim U. Krohne 9
Daniela Suesskind 10
Anna Nguyen-Höhl 11
Marian Liegl 12
Barbara Glitz 13
Ameli Gabel-Pfisterer 14
Stefanie Gniesmer 15
Vinodh Kakkassery 16
Sabine Baumgarten 17
Rainer Guthoff 18
Lars Choritz 19
Andreas Stahl 1
1. Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany, Greifswald, Germany
2. Department of Ophthalmology, University Medicine Bonn, Bonn, Germany, Bonn, Germany
3. Universitatsklinikum Freiburg Klinik fur Augenheilkunde, Freiburg, Germany
4. Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Campus Giessen, Germany, Giessen, Germany
5. Department of Ophthalmology, HELIOS Klinikum Berlin-Buch, Berlin, Germany, Berlin, Germany
6. Department of Ophthalmology, University of Regensburg, Regensburg, Germany, Regensburg, Germany
7. Universitatsklinikum Hamburg-Eppendorf Klinik fur Augenheilkunde, Hamburg, Germany
8. University Eye Hospital, Hannover Medical School, Hannover, Germany, Hannover, Germany
9. Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany, Cologne, Germany
10. University Eye Hospital, Eberhard Karls University of Tuebingen, Tuebingen, Germany, Tuebingen, Germany
11. Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany, Goettingen, Germany
12. Department of Ophthalmology, Vivantes Klinikum Neukoelln, Berlin, Germany, Berlin, Germany
13. Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany, Muenster, Germany
14. Department of Ophthalmology, Klinikum Ernst von Bergmann, Potsdam, Germany, Potsdam, Germany
15. Department of Ophthalmology, University of Luebeck, Luebeck, Germany, Luebeck, Germany
16. Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany, Chemnitz, Germany
17. Department of Ophthalmology, University Hospital RWTH Aachen, Germany, Aachen, Germany
18. Department of Ophthalmology, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany, Duesseldorf, Germany
19. Department of Ophthalmology, Otto von Guericke University, Magdeburg, Germany, Magdeburg, Germany
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Abstract
Purpose: Aggressive (posterior) retinopathy of prematurity (A-ROP/AP-ROP) may progress rapidly into tractional retinal detachment if not treated timely. Fortunately, this type of treatment-warranted ROP is rare in developed countries. As a consequence, data on risk factors for development of this aggressive form of ROP is sparse. In this study, we aim to analyse the risk factors for the development of AP-ROP using data from the German Retina.net ROP registry and report functional outcomes of patients treated for AP-ROP. Methods: We assessed the observational German Retina.net ROP registry for infants born between 2011 and 2020 and treated for unilateral or bilateral aggressive posterior ROP (AP-ROP) (N=21). These infants were compared to infants treated for ROP without AP-ROP (control group; N=329) regarding demographics, neonatal parameters, ROP management and functional outcomes. Results: Of 350 infants treated for any ROP, 21 (6%) were diagnosed with unilateral or bilateral AP-ROP (38 of 686 eyes (5.5%)), predominantly in zone I (77%). Infants with AP-ROP were born at a significantly younger gestational age (24.3 vs. 25.4 weeks; p=0.0001) and with a lower birth weight (595 vs. 697 g; p=0.0262). Treatment occurred at a significantly lower postmenstrual age (PMA) and postnatal age (PNA). Treatment consisted mainly of intravitreal anti-VEGF therapy (79% of eyes) (compared to laser photocoagulation for controls (60%)). Eyes with AP-ROP required more retreatments (39% vs. 15%; p=0.0002). At follow-up of approximately 12 months PNA, 12/15 eyes with AP-ROP had central fixation and 6/15 eyes exhibited strabismus. Median spherical equivalent of eyes with AP-ROP (N=16) was 0.0 dpt (interquartile range: -2.6 to 1.0 dpt). One child developed complete retinal detachment in 1 eye and 1 child partial retinal detachment in 1 eye. Conclusion: Our study confirmed known risk factors for the development of AP-ROP such as low GA and low birth weight, whereas other previously reported risk factors such as male sex and certain comorbidities were not observed in our cohort. Our data provide additional insight into AP-ROP treatment patterns including earlier time of treatment, higher risk for retreatment, and therapy preference for intravitreal anti-VEGF therapy.
Summary
Keywords
AP-ROP, A-ROP, Retinopathy of Prematurity, Risk factors, ROP
Received
20 December 2025
Accepted
05 February 2026
Copyright
© 2026 Bründer, Pfeil, Sassmannshausen, Farassat, Lorenz, Lytvynchuk, Breuss, Barth, Skevas, Karsten, Krohne, Suesskind, Nguyen-Höhl, Liegl, Glitz, Gabel-Pfisterer, Gniesmer, Kakkassery, Baumgarten, Guthoff, Choritz and Stahl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Johanna Madeleine Pfeil
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