360-Degree Sclerosed Vessels and Candle Wax-Like Deposits as an Atypical Exudative Presentation of Aggressive Retinopathy of Prematurity in a Neonate With Severe Anaemia

We report a finding of 360-degree completely sclerosed vessels presenting in aggressive retinopathy of prematurity (A-ROP) in a neonate with severe anaemia. A one-month-old baby with a history of neonatal intensive care unit (NICU) admission for respiratory distress and multiple blood transfusions for systemic anaemia was referred to our hospital with A-ROP. Posterior pole examination revealed candle wax-like exudative deposits along the retinal vessels, with areas of early vascular sclerosis. Ultrawide field fundus photo documentation for both eyes at various presentations, including after the anti-VEGF injections in both eyes, along with laboratory investigations for the systemic evaluation of the baby, was performed. The baby received intravitreal anti-VEGF therapy and was subsequently lost to follow-up. The baby returned three months later and presented with severe systemic anaemia and complete 360-degree vascular sclerosis involving all quadrants, an exceedingly rare and striking presentation. Following prompt correction of the anaemia with blood transfusions, there was dramatic reperfusion of the retinal vasculature, though significant peripheral avascular retina persisted. Laser photocoagulation was performed to treat the persistent avascular retina (PAR). Neonates presenting with ROP and vasculitis-like vascular sheathing may harbour underlying, uncorrected anaemia, warranting thorough systemic evaluation. This highlights the importance of comprehensive monitoring, including detailed retinal vascular assessment and evaluation of haemoglobin levels, thereby preventing progression to extensive vascular sclerosis, as seen in this patient.