This document is a PowerPoint presentation about retinopathy of prematurity (ROP) in 25 pages. It covers the epidemiology, risk factors, pathophysiology, international classification system for ROP (ICROP), prevention, treatment, prognosis, and long-term complications of ROP. The presentation defines ROP as a disorder of the developing retinal vasculature in premature infants that can lead to blindness if left untreated. It describes the two stages of ROP pathogenesis and discusses the roles of insulin-like growth factor-1 and VEGF. Treatment options include surgical procedures like cryotherapy and laser photocoagulation or non-surgical approaches like oxygen regulation and supplements.

1. Retinopathy of Prematurity
Mohammed Nabil J AlAli
5th year medical student
At King Faisal University
Group B (210006209)
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2. Outlines
-Introduction
-Epidemiology
-Risk factors
-Pathophysilogy
-ICROP
-Prevention
-Treatment
-Prognosis
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3. Introduction ( The Retina)
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4. Cut-away of the human eye showing
its essential parts.
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5. Definition
• Retinopathy of prematurity (ROP) was
formerly known as retrolental fibroplasia.
• Disorder of the developing retinal
vasculature resulting from interruption of
normal progression of newly forming
retinal vessels.
• Occurs in the incompletely vascularized
retina of primarily premature infants.
• ROP is one of the most common causes
of blindness in children.
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6. Epidemiology
• The overall incidence of ROP is 16-17%
for all premature infants.
• In infants with birth weight below 1251
grams, the incidence is 66%
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7. Risk Factors
Major risk factors
Associated risk factors
•Decreased gestational age
• Decreased birth weight
•Supplemental oxygen therapy.
•Acidosis
•Apnea
•Patent Ductus arteriousus
•Septicemia,
•Blood transfusions
•Intraventricular
hemorrhage
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8. Pathophysiology
Vascular Development of the Eye
Temporal side
Nasal side
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9. Pathophysiology
• Not well understood but thought to involve two stages:
– Stage I: an initial injury (such as hypotension, hypoxia, or
hyperoxia) causes vasoconstriction and reduced blood flow to
the retina, disrupting the normal process of vascularization.
– Stage II: Vessels then either resume normal growth or new
vessels grow abnormally out from the retina into the vitreous.
The abnormal vessels have increased permeability which can
result in edema and hemorrhage. Inflammation → fibrous tissue
→ traction on the retina and detachment. Alternatively, the
abnormal vascularization may regress with little residual effect.
• Recently, the interaction between insulin-like growth
factor-1 (IGF-1) and VEGF has been studied and
proposed to play a role in the pathogenesis of ROP
(Hellstrom et al. PNAS 2001; 98:5804).
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10. Role of IGF-1 and VEGF in the pathogenesis of ROP
Fig. 5. Schematic representation of IGF-I/VEGF control of blood vessel development in ROP.
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(Hellstrom et al. PNAS 2001; 98:5804)

11. AL Hassa
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12. International Classification for
Retinopathy of Prematurity (ICROP)
• Four features are evaluated:
– Zone (1-3)
– Extent
– Stage (1-5)
– Presence or absence of plus disease
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13. Zones and Extent
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14. Extent
• Described by dividing the retinal surface
into 12 segments (clock hours). The stage
of retinopathy can vary among segments.
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15. Stage I
- A fine, thin demarcation line between the vascular and avascular region is present
-The demarcation line has no height and no thickness
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16. Stage II
A broad, thick ridge clearly separates the vascular from the avascular retina
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17. Stage III
Extraretinal fibrovascular proliferation (neovascularization):
- Sites include the ridge, the posterior surface of the ridge, and anteriorly toward the
vitreous cavity
- The neovascularization gives the ridge a velvety appearance and a ragged border
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18. Stage IV
- Subtotal retinal detachment beginning at the ridge
- The retina is pulled anteriorly into the vitreous by the fibrovascular ridge
(Stage 4A does not involve the fovea)
( Stage 4B involves the fovea)
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19. Stage V
This stage is a total retinal detachment in the shape of a funnel:
(Stage 5A is an open funnel )
(Stage 5B is a closed funnel)
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20. Plus disease
defined as enlarged and twisting blood vessels in
the back part of the eye.
Presence indicates severe ROP and is often followed by rapid progression
to retinal detachment. May be accompanied by vitreous haze, engorgement
of the iris vessels, and poor dilation of the pupil.
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21. Prevention
• Avoiding the risk factors and early interfering.
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22. Treatment
Surgical Procedures
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Cryotherapy
Laser photocoagulation
Scleral Buckle
Vitrectomy
Non-Surgical Procedures
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Oxygen
Light
Vitamins
DHEA
Other Supplements
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23. Prognosis
• 90 % of stage 1-2 regress spontaneously
• 50% of stage 3+ also regress spontaneously
• The other 50% stage 3+, the incidence of
severe visual impairment can be reduced by
~50% with treatment
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24. Long Term Complications of ROP
Strabismus
Retinal Dragging and Folds
Others:
Glaucoma , Late onset Retinal Detachment ,
Significant myopia , Anisometropia , Amblyopia
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25. Any Question ?
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26. Resources
Emedicine (medscape)
(Online Journal of Ophthalmology: www.onjoph.com)
med.stanford.edu
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27. Thank you
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