Spiderweb-like Vessels in Retinopathy of Prematurity

dok_zlo — 04.08.2025

A baby boy was brought to an eye hospital at 8 weeks of age for evaluation and treatment of retinopathy of prematurity. The baby had been born at 25 weeks’ gestation with a birth weight of 850 g and was hospitalized in a neonatal intensive care unit for neonatal respiratory distress syndrome. When the infant was 7 weeks old, an initial eye examination showed retinopathy of prematurity. On ophthalmologic examination at the current presentation, neovascularization of the iris was seen. There was also dilatation and tortuosity of the retinal vessels. Retinal perfusion extended to the posterior retina, indicating severe disease. Intraocular pressures were normal. A decision was made to inject an anti–vascular endothelial growth factor agent. A plastic surgical field and iodine were applied to the eye. The anterior chamber of both eyes was noted to have spiderweb-like vessels that densely covered the anterior lens capsule (as shown in the figure). Retinopathy of prematurity is characterized by delayed retinal vascular development followed by vasoproliferation. Risk factors include prematurity and low birth weight. Early screening and treatment are crucial to prevent blindness. After further treatment with laser therapy when the infant was 17 weeks old, the retinopathy stabilized.
Xinyu Zhao, M.D., Ph.D. and Guoming Zhang, M.D., Ph.D.
Published July 26, 2025
N Engl J Med 2025;393: e7
DOI: 10.1056/NEJMicm2416037
VOL. 393 NO. 5

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