Retinopathy of Prematurity

By Jennie & Vicki

Statistics

• Approximately 30% of all premature infants with a birth weight of under 1500 grams will develop ROP.

• This figure rises to 65% of infants weighing less than 1250 grams.

What is Retinopathy of Prematurity ?

• In the womb the retina (the light sensitive surface at the back of the eye that converts images into nerve signals that the brain understands) develops slowly and the retinal blood vessels often complete growing by the end of gestation.

• If a child is born prematurely these blood vessels can grow abnormally causing damage to the retina.

• The retinal vessels begin forming around 16 weeks of gestation starting around the optic nerve head and migrating out. Vascularisation is completed around 40 weeks when the blood vessels are no longer susceptible to the disease.

What is Retinopathy of Prematurity ?

• Retinal blood vessels retreat and stop growing when exposed to large amounts of oxygen post birth (in utero oxygen saturations are around 65-70% at the highest).

• Phase 1.Vascular endothelial growth factor (VEGF) drops when its exposed to high amounts of oxygen and therefore retinal vessel growth is significantly slowed down.

• Phase 2. is caused by uncontrolled growth due to hypoxia.

Screening• Aim:

ROP which has the potential to reach stage 3.

Severe ROP needing treatment

• Recommended

1st examination at 6-7 weeks age

2 weekly examinations, due to narrow window of opportunity for treatment

Stages of ROP

(Immature retina)

Stage 1, 2: can resolve spontaneouslydemarcation line present, which becomes thickened in stage 2.

Stage 3: may or may not resolvedevelopment of abnormal new blood vessels.

indication of activity involving engorgement of posterior and iris vessels, pupil rigidity and vitreous changes

Stage 4, 5: rare, treatment more complexPartial and complete retinal detachment

How is Retinopathy of Prematurity Treated ?

• Most babies have mild ROP and don’t ever need treatment as the condition self resolves as the grow older.

• For those that have severe ROP, it can cause blindness.

• Various procedures can be done– Destroying the ares of the retina that do not have

blood vessels. This removes the need for the body to produce any more blood vessels.

– Re-attaching the retina after it has been pulled out of position.

– Use anti-VEGF.

Surgery for Retinopathology of Prematurity

• Decision for surgery• Infants requiring ROP treatment will be identified by screening

procedures carried out by ophthalmologist in accordance to guidelines.

• Infants with aggressive ROP require treatment within 48 hours of diagnosis.

• Those less aggressive should receive surgery within 48/ 72 hours.• A neonatal intensive care bed will be required.

• Adequate neonatal staffing should be ensured on day of surgery. • Preparation for treatment.• Routine investigations should be performed FBC, U&E, Blood gas

and Bone profile.