Long-term peripheral retinal and choroidal observations in children with ROP-treated history: a UWF-OCTA study

Abstract Objective To observe the long-term morphological changes in the retina and choroid in children with a history of retinopathy of prematurity (ROP) treated with different modalities, including laser photocoagulation (LP) and anti-vascular endothelial growth factor (anti-VEGF) injections, using ultra-wide-field optical coherence tomography angiography (UWF-OCTA). Methods This cross-sectional study included 39 children (74 eyes), aged 5–16 years, with a history of ROP treatment at Shenzhen Eye Hospital from November 2023 to April 2024. Children were divided into intravitreal injection (IVI) and LP groups. UWF-OCTA imaging was performed with VG 200C SVision Imaging Swept-Source OCT. Quantitative analysis of vessel density (VD), flow area (FA), retinal and choroidal thickness was done, along with the correlation between retinal structure and visual function. Results Baseline characteristics did not differ significantly between the LP and IVI groups (all P > 0.05). Quantitative OCTA analysis showed no significant differences in flow area (FA) or vessel density (VD) within the central 0–6 mm zones at either the deep capillary plexus (DCP) or the inner retina. Beyond 6 mm, however, the Laser group demonstrated consistently higher FA and VD, with disparities increasing toward the perifoveal and peripheral regions (all P < 0.05). Multimodal imaging further revealed peripheral scarring, vascular tortuosity, and retinal-choroidal atrophy in LP-treated eyes, whereas IVI-treated eyes maintained overall retinal structural integrity but exhibited peripheral vascular abnormalities with increased branching and arterio-venous shunting. Conclusions UWF-OCTA revealed that vascular disparities between LP-treated and IVI-treated ROP eyes are predominantly localized to the peripheral retina, highlighting its utility for individualized follow-up, early detection of peripheral complications, and long-term management of ROP-treated children.