Retinopathy of Prematurity (ROP) Service
What is it?
An uncontrolled neovascular process in which retinal vessels proliferate, organize, migrate, scar and cause a detachment of the retina
ROP is a BIOLOGIC process which we currently treat MECHANICALLY
It is the most common cause of permanent blindness in children.
Why ROP?
# No disease at birth
# Child becomes blind before 6 months of age (3.5%- 18% blindness)
# Severe progressive visual loss in others
# Child remains blind for >70 years
# Effective and safe prophylactic treatment available
Classification of ROP
International Classification of Retinopathy of Prematurity (ICROP)
Describe ROP according to -, StageExtentand Zone
3 Zones (location)
Clock hours (extent)
Stages 1 through 5
Plus Disease
Stage 1. Demarcation line-between the normal retina and the non-vascularized retina.
Stage 2 – Ridge of scar tissue and new vessels in place of the demarcation line. The white line now has width and height, and occupies some volume
Stage 3 – Increased size of the vascular ridge , with growth of fibrovascular tissue on the ridge and extending out into the vitreous.
Stage 4 – Partial retinal detachment.
Stage 4A – detachment does not include the macula, and the vision may be good.
Stage 4B – macula is detached, and the visual potential is markedly decreased.Exudative ,tractional , both ..
Stage 5 – Complete retinal detachment
Plus disease – engorgement and tortuosity of the blood vessels near the optic nerve
Aggressive posterior ROP-All 4 Quad post pole tortuosity out of proportion to peripheral retinopathyRapid progression .Do not progress through classic stages
Risk Factors
1.Prematurity
2.Intrauterine growth restriction
3.Male gender
4.Hyperoxia. Note that although the initial epidemic of ROP in the mid 20th century was due to excessive oxygen administration, this is rarely the sole cause in the modern era of saturation monitoring.
5.Erythropoietin (in high cumulative doses), sepsis, blood transfusions, postnatal dexamethasone use and GM-IVH have been implicated as associations, but may reflect extreme prematurity and severity of illness rather than causation.
5.VIT E deficiency
6RDS , PDA ,
7.SHOCK , asphaxia , hypoxia ,hypercarbia
8.Acidosis , alkalosis , sepsis
9.Blood transfusions
ROP: Incidence<1000 grams: 80%
<1250 grams: 60%
Which babies to screen?
The eyes of all infants with the following features should be screened for ROP :
Born at less than 32 weeks.
OR
Weighing less than 2000 g.
OR
Have received supplemental oxygen.
OR
Babies who have other systemic complications, such as intraventricular haemorrhage, are at increased risk of developing ROP.
All pre-terms whose gestational age is not well known
UK Retinopathy of Prematurity Guideline: 2007
All babies <32 weeks gestational age or birth weight <1501g should have their first ROP screening examination prior to discharge.
ROP – Management
A,PREVENTION–
Prevent preterm labor.
(Optimal) minimum use of oxygen.
Prevention of complications.
B,TREATMENToption
Laser/Cryopexy
Anti-VEGF (Avastin)-Intravitrealinj
Vitreoretinal surgery
ROP – Late Sequelae
Myopia – 45% of patients after laser, 75% of patients after scleral buckle
Cataract – 5 % of patients
Late retinal detachment – 4% of patients
Glaucoma – 2% of patients
“Dragging” of the retina and optic disc
Challenges
*Manpower
*Few retina specialists in the country
*Needs more and more training on proper management
*Awareness among the Neonatologists and Paediatricians
*Instruments
