2. INTRODUCTION
• Retinopathy of prematurity (ROP), initially described as retrolental
fibroplasia by Terry in 1942 .
• ROP occurs when abnormal blood vessels grow and spread
throughout the retina, which contains the primary and secondary
neurons for vision.
• These abnormal blood vessels are fragile and can leak, scarring the
retina and pulling it out of position.
• This causes a retinal detachment. Retinal detachment is the main
cause of visual impairment and blindness in ROP.
3. INCIDENCE
• In India, with advancement in neonatal care units a large number of
low birth weight premature babies are now surviving and also due to
better screening protocols there is an apparent increase in the
incidence of ROP.
• In India, approximately, 1 in 1000 children are blind due to ROP. The
incidence of ROP is reported between 24% and 47%., 65% of infants
with birth weight < 1250gm and 80% of those with birth weight <
1000gm will develop some degree of ROP .
(Nair P, Ganesh A, Mitra S, Sham S, Ganguly. Retinopathy of prematurity
in VLBW and extreme LBW babies. Indian J Pediatrics 2003; 70(4): 303-
306)
4. RISK FACTORS
• Decreased IGF1(in utero)
• Delayed delivery time
• Low Birth Weight
• Anemia
• Blood transfusions
• Respiratory distress
• Breathing difficulties
• HIE babies
• Babies fed on high conc. of Oxygen
• Sepsis
• Acidosis
• Hypotension
• Poor weight gain
5. Pathophysiology
• If a baby is born prematurely , before these blood vessels have
reached the edges of the retina, normal vessel growth may stop. The
edges of the retina at the periphery may not get enough oxygen
and nutrients.
• The periphery of the retina suffers physiologic hypoxia due to
increased metabolism of developing neuron,inducing a wave of VEGF
(vascular endothelial growth factor) causing neovascularization.
• As a result, abnormal vessels begin to grow. These new blood vessels
are fragile and weak and easily bleed, leading to retinal scarring.
• When these scars shrink, they pull the retina, causing it to detach
from the back of the eye.
6. • Regulation and monitoring of high oxygen at birth caused ROP to
virtually disappear, but as a result of advances in neonatal care,
premature infants survived at earlier gestational ages and lower birth
weights, and ROP re-emerged to be a serious problem especially in
developing countries like ours.
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12. Whom to screen(KIDROP-Karnataka Internet
Assisted Diagnosis Of ROP)
• All preterm babies with birth wt <1750gm
• GA < 34weeks
• GA upto 36 weeks with Risk factors
• Screening to continue till 44 weeks of GA
• Screen before 30 days of life preferably between 3rd and 4th wk of life
• Between 2nd and 3rd week of life for babies <1200gm/<28wks
13. Precautions and Procedure
• To be done in presence of Neonatologist.
• Step down of NICU is ideal.
• Last feed approx. 1hr prior to examination.
• Use dilute Tropicacyl Plus E/D.
• 1dp 2-3 times 15 mins apart.
• Poor dialation may be an indicator of severe disease.
17. • The Early Treatment for Retinopathy of Prematurity (ETROP) study
results recommended treating ROP with laser photocoagulation. In
zone II or III cases,we preferred laser treatment. In zone I or posterior
zone II cases, we prefer anti-VEGF.
18. Prevention Of ROP
• Target SpO2 - 88-92%.
• Avoid big changes in FiO2 during desaturation episodes.
• Continous display and monitoring of O2 saturation in NICU/SNCU.
• Asepsis precautions to be taken.
• Contact isolation of babies.
• Avoid hypotension.
• Aggressive nutrition as soon as baby is hemodynamically stable.
