Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants. It occurs when the retinal blood vessels in very premature infants grow abnormally and cause scarring at the back of the eye. If left untreated, ROP can cause retinal detachment and blindness. Screening examinations are recommended for high-risk preterm infants to detect ROP early when it is most treatable. Treatment options include laser photocoagulation, cryotherapy, or in severe cases, surgery to prevent blindness from ROP.
7. • Immature retinal vessels
• Oxygen :vasoconstriction and vasoobliterate of
retinal vessels
• Hypoxia
• Retinal neovascularization
• Total retinal detachment
8. 1. Birth weight
2. Gestational age
3. Prolonged (wk.) use of oxygen
4. Blood transfusion
5. Days of respirator used
6. Sepsis
7. Apnea of prematurity
8. Apnea
9. Number of abnormal O2 and CO2
9. 1. Localization
• Zone 1
• Zone 2
• Zone 3
2. Extend of the disease
3. Staging of the disease
12. • Pathognomonic sign : line between avascular
immature peripheral retina and vascularized
posterior retina
• Abnormal terminal arborizations
13.
14. • Line Ridge
• Small isolated neovascular tufts
into the ridge
15.
16.
17. •Fibrovascular proliferation on the ridge
•Fibrovascular proliferation into vitreous
•Retinal blood vessels dilate and tortuous
•Retinal or vitreous hemorrhage
23. • Dilatation of veins and tortuousity of
arterioles in posterior fundus
• Quick and severe progression of the disease
24.
25. • Vascular abnormal dilatation and tortuosity of the
posterior pole than normal
• May progress to frank plus disease
26. • Highly malignant, quickly progressive type
of ROP
• “Ridge” tissue formation & vascular
engorgement progress to complete retinal
detachment within a few days
27. • Lowest –birth weight infants
• Rapid progress severe form of ROP
• Posterior location , Zone 1
• Prominence of plus disease vessels increase
dilatation and tortuosity
36. 1. In premature infant (B.W. < 2000g) with oxygen treatment.
2. Gestational age < 35 wk.
3. Every premature infant B.W. < 1300g & G.A. < 30 wk.
4. Timing
•4-6 wk. after birth = G.A. 28-30 wk.
•When discharge
5. No active ROP sign, repeat every 2 wk. or 1 mo.
6. Active ROP, repeat every week or more
7. After discharge
•No active ROP, repeat until full vascularization
•Active ROP, repeat every 1-2 weeks until regress
37. 1. Dilate pupil by mixture of 1% Tropicamide and
10 % Phenylephrine HCL ratio 9 : 1 for every 5 min.
4-6 times
2. Fundus exam by indirect ophthalmoscope
3. Screening according to guideline
4. Classify by International Classification
38. 1. Laser Photocoagulation
2. Cryotherapy
3. Scleral bucking with or without pars plana
vitrectomy in case of tractional retinal detachment
4. Open sky vitrectomy
5. Bevacizumab (Avastin)
39. 1. AP-ROP
2. Quick progression of ROP from any
stage to stage 3
3. Moderate to sever in fibrovascular proliferation
4. Plus and Pre Plus sign
40. • Bevacizumab
• Genentech Drug
• Intravitreal injection 0.4-0.75 mg
• Very small premy ,low birth weight
• Severe ROP, salvage therapy
• Japan(5eyes),Mexico city (18eyes),
• Portugal (6 eyes), off-lable used
• Need further study
43. • Digital retinal images ( Ret Cam)
• Trained nurses, Doctor
• Digital reading center
• Example: Stanford University Network for Diagnosis of Retinopathy
of Prematurity