ORIGINAL RESEARCH
Ophthalmology
doi: 10.25005/2074-0581-2026-28-3-664-674
EVALUATION OF POSTNATAL PATHOGENETIC FACTORS INFLUENCING THE COURSE AND TREATMENT OUTCOMES OF THRESHOLD-STAGE AND AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY

S.V. LESOVOY1,2, O.S. KRIVOVYAZ1,2, YU.D. KUZNETSOVA1,2, E.A. BOGOMOLOVA3, K.E. CHERENKOVA3, ZH.M. SALMASI3, L.M. BALASHOVA2

1Russian Children's Clinical Hospital – branch of the N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
2International Scientific and Practical Center for Tissue Proliferation, Moscow, Russian Federation
3N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation

Objective: To evaluate postnatal pathogenetic factors influencing the clinical course and treatment outcomes of the active phase of retinopathy of prematurity (ROP), and to assess their relationship with specific management strategies.

Methods: A retrospective analysis was conducted on the medical records of 88 patients (176 eyes) diagnosed with threshold-stage ROP or aggressive posterior ROP (AP-ROP). All patients met the same inclusion criteria: gestational age (GA) at birth of less than 32 weeks, birth weight under 1,500 g, and disease progression leading to threshold-stage ROP. Depending on the management strategy utilized, patients were divided into four groups: • Group 1: 23 children (26%) who received intravitreal injections of ranibizumab. • Group 2: 23 children (26%) who received intravitreal injections of aflibercept. • Group 3: 22 children (25%) who underwent retinal laser photocoagulation. • Group 4: 19 children (22%) who required combination therapy (anti-VEGF + laser photocoagulation and/or surgery).

Results: The most unfavorable clinical course was observed in the combination therapy group, which showed a statistically significant (p=0.01) prevalence of anemia, intraventricular hemorrhage (IVH), and neonatal seizures. This group also had a longer duration of high-frequency oscillatory ventilation, along with more frequent platelet transfusions and erythropoietin (EPO) injections. In the laser photocoagulation group, most patients had threshold stage II disease (38%), whereas only 4% of the aflibercept group had this stage. In children receiving anti-VEGF monotherapy, the average duration of mechanical ventilation was 55 days, which was comparable to that of the combination therapy group.

Conclusion: Postnatal pathogenetic factors including anemia, IVH, neonatal seizures, prolonged respiratory support, and the subsequent need for blood product transfusions and EPO therapy may actively drive ROP progression and adversely affect treatment outcomes. Early identification and clinical optimization of these systemic factors may improve the prediction of disease severity and help guide targeted treatment choices.

Keywords: Retinopathy of prematurity, active phase, threshold-stage ROP, risk factors for progression, prognostic factors, aggressive posterior retinopathy of prematurity.

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Authors' information:

Lesovoy Sergey Valerievich,
Head of the Ophthalmology Department, Russian Children's Clinical Hospital – Branch of the N.I. Pirogov Russian National Research Medical University; Researcher, Department of Experimental and Clinical Ophthalmology, International Scientific and Practical Center for Tissue Proliferation
Researcher ID: MAH-4447-2025
Scopus ID: 35724029200
ORCID ID: 0009-0006-9249-5013
SPIN: 6033-6471
E-mail: sergforester1@mail.ru

Krivovyaz Olga Sergeevna,
Ophthalmology Department Physician, Russian Children's Clinical Hospital – Branch of the N.I. Pirogov Russian National Research Medical University; Researcher, Department of Experimental and Clinical Ophthalmology, International Scientific and Practical Center for Tissue Proliferation
Researcher ID: LZH-6355-2025
ORCID ID: 0009-0001-3768-6283
SPIN: 6115-0644
Author ID: 624189
E-mail: olga-eye@mail.ru

Kuznetsova Yulia Dmitrievna,
Candidate of Medical Sciences, Ophthalmology Department Physician, Russian Children's Clinical Hospital – Branch of the N.I. Pirogov Russian National Research Medical University; Head of the Children's Ophthalmology Service of the International Scientific and Practical Center for Tissue Proliferation
Researcher ID: LZI-2861-2025
Scopus ID: 57216440163
ORCID ID: 0000-0003-4985-7198
SPIN: 9251-6263
Author ID: 572968
E-mail: kuznecovay2011@mail.ru

Bogomolova Ekaterina Aleksandrovna,
Clinical Resident, Department of Ophthalmology, Institute of Motherhood and Childhood, N.I. Pirogov Russian National Research Medical University
ORCID ID: 0000-0003-1764-6599
E-mail: bogomolova.ekaterina.2000@gmail.com

Cherenkova Karina Evgenievna,
Clinical Resident, Department of Ophthalmology, Institute of Motherhood and Childhood, N.I. Pirogov Russian National Research Medical University
ORCID: 0009-0004-4009-2912
E-mail: karinacherenkova4@mail.ru

Salmasi Zhean Mustafaevich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Pathophysiology and Clinical Pathophysiology, N.I. Pirogov Russian National Research Medical University
Researcher ID: MBH-4345-2025
Scopus ID: 6603031386
ORCID ID: 0000-0001-8524-0019
SPIN: 9350-1266
Author ID: 720790
E-mail: profjms@yandex.ru

Balashova Larisa Maratovna,
Doctor of Medical Sciences, Full Professor, Head of the Research Laboratory of Pediatric Ophthalmology, N.I. Pirogov Russian National Research Medical University; General Director, Head of the Department of Experimental and Clinical Ophthalmology, International Scientific and Practical Center for Tissue Proliferation
Researcher ID: MBV-5357-2025
Scopus ID: 59429746600
ORCID ID: 0000-0001-9349-7092
SPIN: 8314-7638
Author ID: 268055
E-mail: blm1962@yandex.ru

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The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Lesovoy Sergey Valerievich
Head of the Ophthalmology Department, Russian Children's Clinical Hospital – Branch of the N.I. Pirogov Russian National Research Medical University; Researcher, Department of Experimental and Clinical Ophthalmology, International Scientific and Practical Center for Tissue Proliferation

119571, Russian Federation, Moscow, Leninsky Prospekt, 117

Tel.: +7 (916) 8035505

E-mail: sergforester1@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

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