title: Extended Follow-up of Treated and Untreated Retinopathy in Incontinentia Pigmenti: Analysis of Peripheral Vascular Changes and Incidence of Retinal Detachment.
abstract: OBJECTIVE
  Extended follow-up of treated and untreated retinopathy in incontinentia pigmenti (IP) has not previously been documented, to our knowledge.
  
  
  OBJECTIVE
  To determine which eyes with IP are at risk for retinal detachment.
  
  
  METHODS
  Observational cohort study of patients with IP who were retrospectively identified at a tertiary care academic center between 1976 and 2013. Fifty eyes of 25 female participants meeting clinical criteria for IP were followed up for at least 6 months. The last year of follow-up was between 1987 and 2014.
  
  
  METHODS
  Progression of retinopathy or the development of retinal detachment was assessed with fluorescein angiography, clinical examination, or both.
  
  
  RESULTS
  The median duration of follow-up was 9.3 years (range, 0.5-22.8 years). Over this period, 11 eyes (22%; 95% CI, 11%-33%) developed retinal detachment. The odds of retinal detachment were increased if there was retinal neovascularization (odds ratio, 11.61; 95% CI, 1.34-100.56; P = .03) or ischemic optic neuropathy (odds ratio, 5.27; 95% CI, 1.61-17.23; P = .006) on initial examination. A bimodal distribution of retinal detachments was observed, with most tractional detachments (7 eyes) occurring by age 2.5 years (median, 1.5 years; range, 14 days-7.0 years) and most rhegmatogenous detachments (4 eyes) occurring in adults (median age, 31.5 years; range, 14.0-47.0 years). Three eyes of young patients (≤2.5 years) developed tractional detachment, despite prophylactic ablation in 4 eyes; only one eye of older patients (≥14.0 years) developed retinal detachment following prophylactic ablation in 6 eyes. Persistent fetal vasculature appears to occur more commonly in IP (14%; 95% CI, 4%-25%) than in the general population.
  
  
  CONCLUSIONS
  All eyes with retinopathy due to IP should be monitored throughout adulthood for the development of retinal complications. During infancy and early childhood, ophthalmoscopic examination should be performed frequently so that prompt treatment can be initiated if there is progressive disease. Because of the nonrandomized nature of this study, the indications for prophylactic ablation and its success rate remain uncertain. Patients with less than 6 months of follow-up were excluded from the analysis, which could have biased this study cohort toward patients with more severe or less severe disease.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Connie J
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Han
authors.affiliation: Wilmer Biostatistics Consulting Center, The Johns Hopkins University, Baltimore, Maryland3Dana Center for Preventive Ophthalmology, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.affiliation: Dana Center for Preventive Ophthalmology, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Muñoz
authors.affiliation: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Morton F
authors.initials: MF
authors.lastname: Goldberg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017679:Cryotherapy; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007184:Incontinentia Pigmenti / Q000150:complications* / Q000175:diagnosis; D007223:Infant; D017075:Laser Coagulation; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors