In the management of retinopathy of prematurity (ROP), which zone and stage combination constitutes PLUS disease and is the MOST important indicator for treatment?

• A Zone III, Stage 2, no plus disease
• B Zone I, Stage 1, no plus disease
• C Zone III, Stage 3 without plus disease
• D Zone II, Stage 3 with plus disease (≥ threshold disease) ✓

Explanation

Treatment for ROP is indicated at threshold disease (originally defined as Zone I or II, Stage 3+ with plus disease for ≥5 contiguous or 8 total clock hours) and at Type 1 ROP (ETROP study): Zone I, any stage with plus disease; Zone I, Stage 3 no plus; Zone II, Stage 2 or 3 with plus disease. The presence of PLUS disease (dilated tortuous posterior pole vessels ≥2 quadrants) is the critical indicator for treatment urgency. Zone III, Stage 2–3 without plus is typically observed. Plus disease in Zone II, Stage 3 is the classic threshold requiring laser photocoagulation or intravitreal anti-VEGF.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.