PROFILE OF ASYMMETRICAL RETINOPATHY OF PREMATURITY IN TWINS.

Background In twin births, both neonates share the same gestational age and prenatal conditions. However, despite these similarities, the progression of retinopathy of prematurity (ROP) can vary between the two, influenced by differences in birth weight, systemic health, and postnatal factors. Identifying asymmetric disease patterns in twins is crucial for refining screening and management protocols. Aim:  To study the profile of asymmetric ROP in twins, analyze differences in disease presentation, and evaluate potential factors influencing the variation in disease severity.  Methods: A retrospective study was conducted at a tertiary ROP referral eye hospital. The medical records of 28 pairs of twins diagnosed with ROP were reviewed. Each pair was analyzed for differences in ROP zone, stage, and disease progression patterns. Additionally, birth weight discordance and other systemic factors were evaluated to determine their impact on disease variability.  Results:In 20 pairs (71.4%), ROP progressed symmetrically in both twins. In 8 pairs (28.6%), there were differences in disease zone or stage, indicating asymmetrical progression. Three pairs demonstrated discordant ROP, where one twin developed the disease while the other remained unaffected. Weight discordance showed no significant correlation with ROP progression patterns.  Conclusion: Twins may present with asymmetric ROP, emphasizing the need for individualized screening and follow-up. Even in cases where both neonates share similar risk factors, disease progression can differ significantly. This study underscores the importance of rigorous and timely screening protocols to ensure early detection and appropriate intervention in both twins.