Retinopathy of Prematurity (ROP) is a retinal disorder that occurs in premature infants with low birth weight. It results from abnormal development of blood vessels that supply the retina. These abnormal blood vessels can grow into the vitreous humor of the eye, leading to the formation of fibrous tissue that may pull on the retina, causing retinal detachment. Early detection and management are essential to reduce the risk of vision loss and the severity of the disease.
Risk Factors
- Infants with a birth weight less than 1,500 grams
- Infants born before 30 weeks of gestation
- Infants who received oxygen therapy for an extended period or with high oxygen concentration
- Infants who underwent blood transfusions
- Infants with respiratory distress syndrome
- Bloodstream infections
Stages of ROP
The severity of ROP is divided into 5 stages:
- Stage 1: There is a clear demarcation line between areas with and without blood vessel growth.
- Stage 2: Thickening of the demarcation line between areas with and without blood vessels.
- Stage 3: New blood vessels grow into the vitreous humor of the eye.
- Stage 4: Partial retinal detachment (subtotal retinal detachment).
- Stage 5: Complete retinal detachment (retinal detachment).
Indications for ROP Screening
- Infants born at or before 30 weeks of gestation, or with a birth weight of 1,500 grams or less.
- Infants born after 30 weeks of gestation, or with a birth weight of 1,500-2,000 grams, who are at risk for developing retinal abnormalities.
Timing for Follow-up Screening
- First screening: At 4-6 weeks after birth, or 31-32 weeks of gestational age (whichever comes later).
- Follow-up screenings: Every 1-4 weeks until retinal blood vessels mature or the disease resolves.
Treatment
Infants should receive treatment within 72 hours if ROP is diagnosed and the disease is severe. Treatment options include:
- Laser Photocoagulation: A diode laser (810 nm wavelength) is used to target areas where blood vessels have not developed.
- Cryotherapy: Freezing therapy applied to the retinal edge.
- Anti-VEGF (vascular endothelial growth factor) injections: Medications that inhibit or remove the new blood vessels in some infants.
- Vitrectomy: Surgery may be required for infants with retinal detachment.
Recommendations
Even if the disease has not progressed to a severe stage requiring treatment, premature infants and those with ROP may experience other problems later in life. It is important for parents to follow up with regular eye exams as recommended by the doctor. Potential complications may include:
- Myopia (nearsightedness), hyperopia (farsightedness), or astigmatism
- Strabismus (crossed eyes)
- Amblyopia (lazy eye)
- Retinal detachment
- Cataracts or glaucoma at a young age
