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Retinopathy of pre-maturity (ROP)


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Retinopathy of pre-maturity (ROP)

  2. 2. RETINOPATHY- Non-inflammatory disease of the retina. PREMATURITY-Bilateral proliferative retinopathy,occurring in premature infants. DEFINATION: A premature infant of low birth weight exposed to a high ambient oxygen concentration.
  3. 3. ETIOPATHOGENESIS: Vascularization of peripheral retina. In the normal development of retina , the vessels reach the retina after 8 months of gestation and temporal periphery about 1 month after delivery.
  4. 4. LOCATION OF DISEASE (ZONES OF INVOLVEMENT) OF ROP: -Bounded by an imaginary circle. -Extends from the edge of zone I. -Consists of residual temporal crescent. ZONE I ZONE II ZONE III
  5. 5. LOCATION OF DISEASE (ZONES OF INVOLVEMENT) OF ROP: Division of retina into zones (l,ll,lll) and clock hour positions to depict involvement in retinopathy of prematurity. Contd…
  6. 6. Progression of retinopathy of prematurity
  7. 7. STAGE I: Demarcation line. Vascularised retina Demarcation line Avascular retina
  8. 8. STAGE II: Ridge. Isolated neovascular tufts Ridge An elevated ridge of mesenchymal tissue is present at the border of the vascular and avascular retina
  9. 9. STAGE III: Extra retinal fibrovascular proliferation. Severe extra retinal fibrovascular proliferation.
  10. 10. STAGE IVA: Macula is not involved.
  11. 11. STAGE IVB: Macula is involved.
  12. 12. STAGE V:Retinal Detachment. Detached Retina
  13. 13. OTHER FEATURES: 1. Plus Disease- Signifies a tendency to progress. Vascular dilation in retinopathy of prematurity ‘plus’ disease
  14. 14. 2.Pre-plus disease- Abnormal dilatation which is not sufficient to be designated as plus disease. 3.Rush disease- Refers to ROP located in zone I with plus disease. Aggressive posterior ROP
  15. 15. 4.Threshold disease- Refers to stage III ROP. Threshold ROP in premature infant with stage 3 disease bordering zone 1 and zone 2 and the presence of plus disease
  16. 16. DIFFERENTIAL DIAGNOSIS: Familial exudative vitreoretinopathy (FEVR). Advanced retrolental fibroplasia. SCREENING AND MANAGEMENT:  Mature retina – Is labelled when the vessels have reached within one disc diameter of both nasal and temporal ora-serrata.  Immature retina- Is labelled when the vessels are short of one disc diameter of the nasal or temporal ora but ROP is not developed yet.  Reninopathy of prematurity- ROP is detected.
  17. 17. TREATMENT:  Laser Photocoagulation. Laser photocoagulation for threshold ROP- A. Threshold eye prior to laser therapy. B. Immediately after laser therapy. C. 1 week after laser therapy. D. 3 months after laser therapy.
  18. 18. REFERENCE:  Comprehensive Ophthalmology- By A.K. Khurana.  Clinical Ophthalmology- By Jack J. Kanski. 