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Twin–twin transfusion syndrome as a possible risk factor for the development of retinopathy of prematurity

  • Pediatrics
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The objective of this study was to evaluate the correlation between twin–twin transfusion syndrome (TTTS) and the development of retinopathy of prematurity (ROP) in premature infants.


Fifty-one infants who were less than 32 postmenstrual gestational weeks at birth or with a birth weight less than 1,501grams were included in this longitudinal observational study. The infants were matched by gestational age and birth weight, and divided into three groups: multiples with TTTS, multiples without TTTS, and singletons. The primary outcome variable was the incidence of ROP in infants affected by TTTS versus infants not affected by TTTS. Secondary outcome variables were multiple pregnancy, gestational age, and birth weight.


Infants affected by TTTS showed a significantly higher incidence of ROP than infants not affected by TTTS (p < 0.01). TTTS donors and TTTS recipients were both at greater risk of developing ROP. ROP occurred in infants with TTTS whose gestational age at birth was significantly higher than that of infants with ROP who were not affected by TTTS (p = 0.01). Multiple pregnancy itself was not a risk factor for ROP disease.


Infants affected by TTTS during pregnancy are at high risk of developing ROP, even if they were born at an older gestational age. Special awareness in ROP screening is necessary for these infants.

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All authors made substantial contributions to (1) conception and design (AG, ES, TN, EM, AP, GD, USE), data acquisition (AG, ES, TN), and/or data analysis and interpretation (AG, ES, TN, EM, AP, GD, USE); (2) drafting of the article (AG) and/or critical revision for important intellectual content (ES, TN, EM, AP, GD, USE); and (3) final approval of the version to be published (AG, ES, TN, EM, AP, GD, USE).

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All authors declare that no competing interests exist.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Ethics Committee of the Medical University of Vienna, Vienna, Austria.

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Correspondence to Eva Stifter.

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Gschließer, A., Stifter, E., Neumayer, T. et al. Twin–twin transfusion syndrome as a possible risk factor for the development of retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 253, 151–156 (2015).

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