2. Definition
• Retinopathy of prematurity (ROP) is a retinal
disorder of low birth weight premature
infants. It can be mild with no visual defect, or
it may become aggressive with new vessel
formation and progress to retinal detachment
and blindness.
Retinopathy of prematurity CPG MOH 2005
3. Pathogenesis
• There is an initial failure of normal retinal
vascularization followed by a phase of
aggressive new vessel formation extending
forward into the vitreous and causing traction
detachment.
4. Risk factor
• Gestation less than 32 weeks
• Birth weight below 1500g – incidence btwn 34 to 60%
• Exposure to supplemental oxygen
• Apnoea
• Sepsis
• Duration of ventilation
• Blood transfusion
• The presence of interventricular hemorrhage
• Retinal light exposure
5. Signs
The retinal appearance depend on the severity
of the condition but includes:
• New vessel
• The development of retinal hemorrhage
• Increase tortuosity and dilatation of the retina vessel
In severe disease, blindness can result from:
• Bleeding into the vitreous
• Retinal detachment
6. Stages of ROP
Stage 1 Mildly abnormal blood vessel growth. Many children who dev this stage
improved with no tx and eventually
dev normal vision. Ds resolved on its
own without further progression.
Stage 2 Moderately abnormal blood vessel
growth.
Stage 3 Severely abnormal bv growth. the
abnormal bv grow towards the center
of the eye instead of following their
normal growth pattern along the
surface of the retina.
Some infant would improve with no
tx. However, if infant have stage 3
and plus ds, tx was considered. Plus
disease – bv of the retina have
become enlarged and twisted ,
indicate worsening of the ds. (tx at
this point has a good chance of preventing
retinal detachment)
Stage 4 Partially detach retina. Traction from the scar produced by
bleeding, abnormal vessel pulls the
retina away from the wall of the eye.
Stage 5 Completely detach retina . if left untreated, baby can have
severe visual impairment and even
blindness.
National Eye Institute
7.
8. Treatment
• At risk infant are screened on a regular basis.
The severe complication of the condition can
be reduced by applying cryotherapy or laser to
the avascular retina.
9.
10. Screening
Screening should be carried out for the infants with either:
• Birth weight less than 1500g or
• Gestational age less than 32 weeks or
• Infants with an unstable clinical course who are at
high risk
First examination should be done by 4 to 6 weeks after birth
11. Screening of all infants at risk of developing ROP
should be continued regularly until:
• Retina is completely vascularised
• ROP has fully regressed and there are no sign of risk
of visual loss
• ROP has progressed to a severity where treatment is
indicated
