Retinopathy of prematurity (ROP) is screened in neonates born at ≤32 weeks gestational age and/or birth weight ≤1500 g. The MOST aggressive form of ROP requiring immediate treatment is:

• A Stage 2 ROP in zone II without plus disease
• B Aggressive posterior ROP (AP-ROP) in zone I with flat neovascularization and plus disease ✓
• C Stage 3 ROP in zone II with plus disease (type 1 ROP)
• D Stage 4A (partial retinal detachment sparing fovea) without plus disease

Explanation

Aggressive posterior ROP (AP-ROP, formerly Rush disease) is the most severe, rapidly progressive form. It occurs in zone I or posterior zone II, has prominent plus disease (tortuous vessels, dilated veins in ≥2 quadrants), flat neovascularization at the junction, and progresses to retinal detachment within days without treatment. It does not follow the usual stage 1→5 progression. Type 1 ROP (Stage 3+ in zone I any; stage 2 or 3 with plus in zone II) is the standard treatment threshold. AP-ROP requires immediate anti-VEGF injection (bevacizumab) or laser, with anti-VEGF preferred in zone I disease.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.