Zone 3 Aggressive Retinopathy of Prematurity in a Near-Term Delivered Big Baby With a Birth Weight of 3,200 g

Aggressive retinopathy of prematurity (A-ROP) represents a severe, rapidly progressive variant of retinopathy of prematurity (ROP) that is most observed in extremely premature, low-birth-weight infants and usually involves the posterior zones. Its occurrence in near-term infants with normal birth weight, involving Zone 3, is rare. This report dwells upon such a rare occurrence. This is a case of a male baby born at 37 weeks' gestation with a birth weight of 3,200 g. The baby required a neonatal ICU (NICU) admission for 13 days for respiratory distress and seizures. At a postmenstrual age of 40 weeks, fundus examination revealed A-ROP in both eyes in Zone 3. After parental counseling, bilateral intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy with bevacizumab (one-third adult dose, 0.4 mg/0.015 mL) was administered. The infant showed rapid regression of plus disease and hemorrhages. Subsequent follow-ups demonstrated continued improvement, with complete retinal maturation by six months. At the final follow-up, the child had a mature retina, an unremarkable anterior segment, and a refraction of +0.50 DS/-2.00 DC × 180° in both eyes. This case highlights a rare presentation of A-ROP involving Zone 3 in a near-term, normal birth-weight infant. The potential role of postnatal factors, including respiratory distress management, in the development of A-ROP outside traditional risk profiles. The prognosis is good if the condition is treated promptly and there is no further systemic deterioration.