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.

1. Retinopathy of Prematurity
(ROP)
By Dr. Irene Subharngkasen M.D.
กลุมงานจักษุวิทยา สถาบันสุขภาพเด็กแหงชาติมหาราชินี

2. •Retinopathy of prematurity (ROP)
•Retrolental fibroplasia
•Abnormal retinal vascularization of premature infant
•Retinal detachment and cicatrization

3. 1942 Terry : Retrolental Fibrophasia (RLF)
1951 Heath : Pathology of RLF, ROP
1951 Cambell and Patz : Intensive oxygen therapy ~ ROP
Reese : classification by direct ophthalmoscope
1977 Kingham : classification by indirect ophthalmoscope
term “ROP” replaced term “RLF”
1982 International classification of ROP
1987 AP-ROP, Pre-plus disease

4. • Active stage
• Cicatricial (regressed) stage

5. Retinal vessels
• Optic disc 16 weeks
• Nasal 36 weeks
• Temporal 40 weeks

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

11. Stage 1 Stage 2
Stage 3 Stage 4 Stage 5

12. • Pathognomonic sign : line between avascular
immature peripheral retina and vascularized
posterior retina
• Abnormal terminal arborizations

14. • Line Ridge
• Small isolated neovascular tufts
into the ridge

17. •Fibrovascular proliferation on the ridge
•Fibrovascular proliferation into vitreous
•Retinal blood vessels dilate and tortuous
•Retinal or vitreous hemorrhage

19. •Severe fibrovascular proliferation
•Tractional retinal detachment

23. • Dilatation of veins and tortuousity of
arterioles in posterior fundus
• Quick and severe progression of the disease

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

29. 80% of cases of ROP regress

30. 1. Plus disease
2. Vitreous haze
3. Pre-retinal and vitreous hemorrhage
4. Engorgement of iris vessels
5. Failure of the pupil to dilate

31. ปงบประมาณ
2549 2550 2551
ผลการรักษา
จํานวนผูปวย ROP (คน) 481 558 570
225 239.5 246
ตรวจพบ ROP (คน)
46.77% 42.92% 43.15%
120.5 144 167.5
รักษาดวยการจี้ความเย็นหรือ Laser (คน)
25.05% 25.80% 29.38%
รักษาหาย (คน) 89.5 105 118.5
เปอรเซ็นตการหาย 82.8% 86.1% 91.10%

32. • ROP • Stage 3(severe)
–< 1250 g. = 66% – 1000 - 1250 g. = 8.5%
–< 1000 g. = 82% – 750 - 999 g. = 21.9%
–< 750 g. = 90% – < 750 g. = 37%

33. • ทารกน้ําหนักแรกคลอด < 1251 กรัม 4099 คนพบ ROP 65.8%
น้ําหนักแรกคลอด พบ ROP
1001-1250 กรัม 47%
751-1000 กรัม 78%
< 750 กรัม 90%

34. รายใดจําเปนตองรับการตรวจตา โดยจักษุแพทย
แนวทางการตรวจคัดกรองของ สถาบันสุขภาพเด็กฯ
กรมการแพทย / AAP & AAO
น้ําหนักแรกคลอด ≤ 1500 กรัม ≤ 2000 กรัม
อายุครรภ ≤ 28 สัปดาห ≤ 35 สัปดาห

35. แนวทางการตรวจคัดกรองของ
สถาบันสุขภาพเด็กฯ
กรมการแพทย / AAP & AAO
4-6 week
4-6 week
31-33 week
31-33 week
(Post conception age)
(Post conception age)
Follow up
q 1-4 week until refress

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

42. เครื่องถายภาพจอประสาทตา Retinal Camera
(Ret-cam®)

43. • Digital retinal images ( Ret Cam)
• Trained nurses, Doctor
• Digital reading center
• Example: Stanford University Network for Diagnosis of Retinopathy
of Prematurity

44. 20% of active ROP Cicatricial complication

47. 1. Minimal peripheral retinal pigmentary
disturbance and haze at the vitreous base
2. Myopia
3. Peripheral retinal breaks and lattice
degeneration
4. Fibrous band, at temporal retinal periphery
5. Traction of retinal blood vessels
6. Retrolental cyclitic fibro vascular sheets
7. Funnel-shaped total retinal detachment
8. Secondary angle-closure glaucoma