Retinopathy of prematurity

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retinopathy of prematurity

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  • Figure 18: Fundus photograph with example of plus disease.
  • Figure 3: Fundus photograph to illustrate the demarcation line of stage 1.
  • Figure 4: Another example of demarcation line seen in stage ROP (see arrows)
  • Figure 5: Fundus photograph showing Stage 2 ROP at the junction between vascularized and avascular retina.
  • Figure 6: Fundus photograph showing the ridge between vascularized and avascular retina characteristic of stage 2 ROP (single arrow). Small isolated tufts of new vessels (popcorn) lie on the retinal surface (small white arrows). Note also stage 3 ROP is present in the left hand portion of the photograph (double arrow).
  • Figure 7: Fundus photograph of “mild” to “moderate” stage 3 ROP. This represents progression of the ROP imaged in Figure 4.
  • Figure 8: Fundus photograph showing stage 3 “moderate” ROP with fingerlike extensions posterior to the ridge. Note that the posterior pole vessels show increased tortuosity and dilation.
  • Figure 9: Fundus photograph showing “moderate” stage 3 ROP.
  • Figure 10: Fundus photograph showing “moderate” stage 3 ROP. Substantial amounts of extraretinal fibrovascular proliferation are seen infiltrating the vitreous posterior to the ridge (white arrow). Note the tortuosity and dilation of posterior pole vessels that is insufficient for plus disease.
  • Figure 11: Fundus photograph demonstrating “severe” stage 3 ROP with massive infiltration of neovascular tissue surrounding the ridge.
  • Figure 12: Fundus photograph showing “severe” stage 3 ROP with infiltration of the vitreous with a dominantly fibrotic proliferation.
  • Figure 14: Fundus photograph of stage 4B, partial retinal detachment involving macula. Note absence of normal choroidal pattern in macular region.
  • Figure 15: Fundus photograph showing stage 4B retinal detachment with extensive temporal dragging of vessels and macula.
  • Figure 16: Photograph of stage 5 ROP, total retinal detachment with open funnel configuration.
  • Figure 17: Photograph of stage 5 funnel retinal detachment that is open anteriorly but narrowed posteriorly.
  • Retinopathy of prematurity

    1. 1. ‫بسم ا الرحمن الرحيم‬ ‫‪ROP‬‬
    2. 2. Retinopathy of prematurity http://oftalmologo.bravepages.co m/Leucocoria%201.jpg By DR/Mohamed Abdel-Aziz M.SC(ophthalmology) www.nyee.edu/images/ar038.jpg
    3. 3. ROP-Definition Retinopathy of prematurity (ROP): Is an ischemic retinopathy of premature and low-birth-weight infants.
    4. 4. ROP : Risk Factors  Gestational age: less than 32 weeks  Birth weight: less than 1500 gm  Oxygen therapy : Excessive oxygen use
    5. 5. Retinal vascularization Nasal side Temporal side
    6. 6. Timing of vascularization of the peripheral retina
    7. 7. ROP -Classification -Classificatio
    8. 8. International ClassificationConceptual Overview  Zone : describes the extent of vascularization.  Stage : describes the degree of vascular pathology.  Sectors : Clock hours used to quantify the circumferential extent pathology.  Plus Disease : describes the activity of the disease.
    9. 9. International Classification – Zones  Zones: Zone 1 is posterior, Zone 2 is equatorial and Zone 3 is anterior.  Zone 1 – High Risk  Zone 2 – Intermediate Risk  Zone 3 – Low Risk
    10. 10. Zone 3 Zone 2 Zone 1
    11. 11. ROP – Classification – Zones 12 12 I 9 III I 3 II 9 II I III Ora serrata Macula 6 Right eye 6 Optic disc Left eye 3
    12. 12. International Classification-Stages  Stage 1 – Demarcation Line – Low Risk  Stage 2 – Ridge --Intermediate Risk  Stage 3 – Fibrovascular proliferation -- High Risk  Stage 4 – Partial Retinal Detachment  Stage 5 – Total Retinal Detachment
    13. 13. ROP Classification-Stages Stage 1. Demarcation line between the normal retina (left) and the nonvascularized retina (right).
    14. 14. ROP Classification- Stages  Stage 2 - ridge (R) of scar tissue and new vessels in place of the demarcation line. The white line now has width and height, and occupies some volume.  Small tufts of new vessels ("popcorn vessels")
    15. 15. ROP Classification-Stages  Stage 3 - Increased size of the vascular ridge , with growth of fibrovascular tissue on the ridge and extending out into the vitreous.  Fibrous scar tissue is beginning to form in this stage, with attachments between the vitreous gel and the ridge.
    16. 16. ROP Classification-Stages  Stage 4 - Partial retinal detachment.  Stage 4A - detachment does not include the macula, and the vision may be good.  In Stage 4B - macula is detached, and the visual potential is markedly decreased.  Stage 5 - Complete retinal detachment.
    17. 17. International Classification —Stages--Sectors  Clock hours refer to 30 degree sectors around the eye.
    18. 18. 12 1 Zone 3 Sectors = 30 degrees 2 Zone 2 3 Zone 1 Pathology described by clock hours e.g. stage 3 from 2-3
    19. 19. -Plus disease  Posterior arterial tortuosity and venous dilation  Iris vessel dilation and rigidity  Vitreous haze
    20. 20. Plus Disease
    21. 21. Stage 1
    22. 22. Stage 1
    23. 23. Stage 2
    24. 24. Stage 2 Popcorn
    25. 25. Stage 3
    26. 26. Stage 3 Moderate
    27. 27. Stage 3 Moderate
    28. 28. Stage 3 Moderate
    29. 29. Stage 3 Severe
    30. 30. Stage 3 Severe
    31. 31. Stage 4B
    32. 32. Stage 4B
    33. 33. Stage 5
    34. 34. Stage 5
    35. 35. ROP - Management Managemen
    36. 36. ROP - Management  PREVENTION Prevent preterm labor. (Optimal) minimum use of oxygen. Prevention of complications.
    37. 37. ROP - Management  SCREENING All infants < 34 wks gestational age AND < 1500 g birth weight are screened between 4-6 weeks of age.
    38. 38. Treatment Criteria  Treat when threshold ROP is reached.  Threshold ROP:  5 contiguous clock hours or 8 total clock hours of stage 3 and plus disease in zone 1 or 2.
    39. 39. ETROP Recommendations Stage 1 2 Plus <48hr Treat <48hr Stage 2 Treat <48hr Treat <48hr Follow No Change Stage 2 Follow weekly Follow twice weekly Stage 1 No Plus Treat Stage 3 Z o n e twice weekly Stage 1 Plus Follow Stage 3 1 Stage 2 Stage 1 No Plus twice weekly Stage 3 Z o n e Follow Follow No Change Stage 2 Treat <48hr Stage 3 Treat <48hr
    40. 40. Treatment Options  Cryotherapy  Laser photocoagulation – standard treatment  Surgical interventions Scleral buckling Vitrectomy
    41. 41. New treatment options for ROP  Avastin alone for ROP stage 3 may become primary treatment replacing LASER therapy (Helen et al.,2009).  Recently ,chen et al., report in a retrospective study effective outcomes using trans-scleral diode laser instead of transpupillary laser treatment for threshold ROP(Chen et al.,2011)
    42. 42. LASER therapy for Zone I ROP, macular dragging and 17 diopters of myopia Intravitreal Avastin for Zone I ROP, NO macular dragging nor myopia
    43. 43. Long Term Complications of ROP Retinal Dragging and Folds Others: Glaucoma Late onset Retinal Detachment Significant myopia Anisometropia Strabismus Amblyopia
    44. 44. Who ? 1. < 28 weeks gestation or 2. < 1500 gms or 3. > 1500 gms if unstable REMEMBER THIS !!!
    45. 45. When ?  Examine 4 –6 weeks after birth REMEMBER THIS !!!
    46. 46. Conclusion  Ultimate prevention = prevent premature births.  ROP is a lifelong disease with sequelae manifesting into the 2nd decade.  Surgical intervention preserves vision in ROP-related retinal detachment esp. before macular detachment.

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