{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:16:30Z","timestamp":1787940990215,"version":"build-2784847793"},"reference-count":45,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,8,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>Aggressive retinopathy of prematurity (A-ROP) is a severe subtype of ROP that can require repeated treatment yet risk factors for retreatment remain incompletely defined. This study aims to identify risk factors for anti-vascular endothelial growth factor (VEGF) re-injection in A-ROP across US-born and non-US-born infants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from premature infants with ROP were collected across 23 sites (16 USA, 7 non-USA) from 2007 to 2021. A-ROP re-injection risk was evaluated using generalised estimating equations, adjusted for birth weight (BW), gestational age (GA) at birth, ROP zone at injection, hospital site and initial anti-VEGF agent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1677 examined eyes, 1600 had ROP; 283 had A-ROP (mean BW 712\u2009g, mean GA 24.8 weeks) and 1317 had non-A-ROP (mean BW 812\u2009g, mean GA 25.9 weeks). Infants with A-ROP had lower mean BW and GA (p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.001). Across A-ROP cases, each 100\u2009g increase in BW decreased re-injection risk by 26% (p=0.041). Compared with bevacizumab, ranibizumab was associated with a higher risk of re-injection in A-ROP eyes (risk ratio=4.82, p=0.009). ROP zone II was associated with a 2.48-fold higher risk of re-injection than zone I (p\n                      <jats:italic>=<\/jats:italic>\n                      0.014), which was attenuated after correction for bilaterality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>A-ROP is associated with lower BW, lower GA at birth and more posterior ROP zone than non-A-ROP. Lower BW and initial ranibizumab treatment are related to greater risk of repeat anti-VEGF injection. There was more retreatment in zone II A-ROP eyes compared with those in zone I, which did not persist after correction for bilaterality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-330184","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:20:22Z","timestamp":1787937622000},"page":"bjo-2026-330184","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Aggressive retinopathy of prematurity: characteristics and risk factors for retreatment"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1498-5736","authenticated-orcid":false,"given":"Jonathan Z","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"},{"name":"The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1601-885X","authenticated-orcid":false,"given":"Celine","family":"Chaaya","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"},{"name":"Department of Ophthalmology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"},{"name":"The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naira","family":"Ikram","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Altamirano","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3922-360X","authenticated-orcid":false,"given":"Sandra","family":"Hoyek","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"},{"name":"Department of Ophthalmology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Brant","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis A","family":"Acaba-Berrocal","sequence":"additional","affiliation":[{"name":"Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth C","family":"Fan","sequence":"additional","affiliation":[{"name":"Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Ana","family":"Mart\u00ednez-Castellanos","sequence":"additional","affiliation":[{"name":"Association to Prevent Blindness, Hospital Dr. Luis S\u00e1nchez Bulnes, National Autonomous University of Mexico, Mexico City, CDMX, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3651-8210","authenticated-orcid":false,"given":"Caroline R","family":"Baumal","sequence":"additional","affiliation":[{"name":"Apellis Pharmaceuticals, Waltham, Massachusetts, USA"},{"name":"Retina Specialists of Boston and Wellesley, Wellesley, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Clio Armitage","family":"Harper","sequence":"additional","affiliation":[{"name":"Austin Retina Associates, Austin, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audina M","family":"Berrocal","sequence":"additional","affiliation":[{"name":"Bascom Palmer Eye Institute, University of Miami Leonard M. 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