This document provides information on Retinopathy of Prematurity (ROP), including its history, risk factors, pathophysiology, screening guidelines, physical exam findings, classification system, management, and termination of screening criteria. ROP is a serious eye disorder in premature infants that can lead to blindness. It results from disrupted retinal vascular development due to premature birth. The smallest and sickest preterm infants have the highest risk. Screening is important and involves examination to stage the ROP based on location and severity. Management may include frequent follow-up exams or treatment depending on ROP stage.
This document discusses retinopathy of prematurity (ROP), which occurs in premature infants who are exposed to high oxygen levels. Key points:
- ROP occurs when retinal vessels do not fully develop due to preterm birth. High oxygen can damage capillaries.
- Risk factors include low birth weight (<1500g), young gestational age (<32 weeks), and high oxygen exposure.
- ROP is diagnosed using an eye exam and classified by location, severity, and vascular characteristics. Treatment may include laser therapy or anti-VEGF injections depending on the stage and severity. Regular screening of high-risk infants allows for early detection and treatment.
Retinopathy of Prematurity is a disease that affects the eyes of premature babies. It was previously known as Retrolental Fibroplasia. Studies have found the incidence of ROP to be between 22-40% in India, depending on the region and risk factors like low birth weight and oxygen therapy. Screening and treatment of ROP has advanced with the use of wide field retinal imaging and laser therapy replacing cryotherapy. Studies like CRYO-ROP and ETROP have shown that early treatment of high-risk prethreshold ROP improves visual outcomes.
ROP current understanding and managementFarhadul Alam
Retinopathy of prematurity (ROP) is a vascular disease of the eye unique to preterm infants characterized by failure of retinal blood vessels to grow and develop normally. It results in severe visual impairment and blindness in newborns.
seminar on Retinopathy of prematurity by Dr Anindita boseDr. Habibur Rahim
This document provides an overview of retinopathy of prematurity (ROP). It begins with a case scenario describing a preterm infant diagnosed with ROP. It then discusses the incidence, risk factors, classification, diagnosis, screening criteria, and treatment of ROP. The presentation covers the pathogenesis, embryology of retinal vessels, international classification system involving zones and stages of ROP severity. It also describes criteria for timely screening and treatment to prevent vision loss from this leading cause of childhood blindness.
This document provides an overview of retinopathy of prematurity (ROP). It begins with a case scenario of an infant diagnosed with ROP and treated during their NICU course. It then discusses the history, incidence, risk factors, classification, diagnosis, screening criteria, and treatment of ROP. The presentation covers the embryology of retinal vessels, pathogenesis of ROP, international classification system for ROP (including zones, stages, plus disease), screening recommendations, treatment modalities including laser photocoagulation and cryotherapy, and prognosis. The goal of the document is to provide attendees with a comprehensive understanding of ROP.
The document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is abnormal retinal blood vessel development in premature infants that can lead to blindness if left untreated.
- Risk factors include very preterm birth and low birth weight.
- International classification system grades ROP by zone, stage, extent, and presence of "plus disease".
- Timely screening by an ophthalmologist using binocular indirect ophthalmoscopy is key to diagnosis.
- Treatment such as laser photocoagulation or cryotherapy aims to destroy undeveloped retina and prevent further progression when ROP reaches threshold or pre-threshold levels.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants. It occurs when the retina of premature infants develops abnormally as a result of interrupted retinal vascularization. The disease ranges in severity from mild to severe, with the most severe cases resulting in retinal detachment and blindness. Screening for ROP involves examining the retina using indirect ophthalmoscopy starting between 20-30 days of life in infants born before 34-35 weeks gestation and/or weighing 1500g or less. Treatment options depend on the stage of ROP and may include laser therapy or anti-VEGF injections to prevent further progression. Affected infants require long-term follow-up to monitor vision and eye
Retinopathy of prematurity (ROP), initially described as retrolental fibroplasia one of the leading cause of blindness in children.
Despite advances in diagnosis and treatment, as medicine and technology advances and premature infants are surviving at earlier gestational ages, ROP continues to be a significant problem.
ROP results in disorganized growth of retinal blood vessels, which may lead to scarring and retinal detachment.
This document discusses retinopathy of prematurity (ROP), which occurs in premature infants who are exposed to high oxygen levels. Key points:
- ROP occurs when retinal vessels do not fully develop due to preterm birth. High oxygen can damage capillaries.
- Risk factors include low birth weight (<1500g), young gestational age (<32 weeks), and high oxygen exposure.
- ROP is diagnosed using an eye exam and classified by location, severity, and vascular characteristics. Treatment may include laser therapy or anti-VEGF injections depending on the stage and severity. Regular screening of high-risk infants allows for early detection and treatment.
Retinopathy of Prematurity is a disease that affects the eyes of premature babies. It was previously known as Retrolental Fibroplasia. Studies have found the incidence of ROP to be between 22-40% in India, depending on the region and risk factors like low birth weight and oxygen therapy. Screening and treatment of ROP has advanced with the use of wide field retinal imaging and laser therapy replacing cryotherapy. Studies like CRYO-ROP and ETROP have shown that early treatment of high-risk prethreshold ROP improves visual outcomes.
ROP current understanding and managementFarhadul Alam
Retinopathy of prematurity (ROP) is a vascular disease of the eye unique to preterm infants characterized by failure of retinal blood vessels to grow and develop normally. It results in severe visual impairment and blindness in newborns.
seminar on Retinopathy of prematurity by Dr Anindita boseDr. Habibur Rahim
This document provides an overview of retinopathy of prematurity (ROP). It begins with a case scenario describing a preterm infant diagnosed with ROP. It then discusses the incidence, risk factors, classification, diagnosis, screening criteria, and treatment of ROP. The presentation covers the pathogenesis, embryology of retinal vessels, international classification system involving zones and stages of ROP severity. It also describes criteria for timely screening and treatment to prevent vision loss from this leading cause of childhood blindness.
This document provides an overview of retinopathy of prematurity (ROP). It begins with a case scenario of an infant diagnosed with ROP and treated during their NICU course. It then discusses the history, incidence, risk factors, classification, diagnosis, screening criteria, and treatment of ROP. The presentation covers the embryology of retinal vessels, pathogenesis of ROP, international classification system for ROP (including zones, stages, plus disease), screening recommendations, treatment modalities including laser photocoagulation and cryotherapy, and prognosis. The goal of the document is to provide attendees with a comprehensive understanding of ROP.
The document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is abnormal retinal blood vessel development in premature infants that can lead to blindness if left untreated.
- Risk factors include very preterm birth and low birth weight.
- International classification system grades ROP by zone, stage, extent, and presence of "plus disease".
- Timely screening by an ophthalmologist using binocular indirect ophthalmoscopy is key to diagnosis.
- Treatment such as laser photocoagulation or cryotherapy aims to destroy undeveloped retina and prevent further progression when ROP reaches threshold or pre-threshold levels.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants. It occurs when the retina of premature infants develops abnormally as a result of interrupted retinal vascularization. The disease ranges in severity from mild to severe, with the most severe cases resulting in retinal detachment and blindness. Screening for ROP involves examining the retina using indirect ophthalmoscopy starting between 20-30 days of life in infants born before 34-35 weeks gestation and/or weighing 1500g or less. Treatment options depend on the stage of ROP and may include laser therapy or anti-VEGF injections to prevent further progression. Affected infants require long-term follow-up to monitor vision and eye
Retinopathy of prematurity (ROP), initially described as retrolental fibroplasia one of the leading cause of blindness in children.
Despite advances in diagnosis and treatment, as medicine and technology advances and premature infants are surviving at earlier gestational ages, ROP continues to be a significant problem.
ROP results in disorganized growth of retinal blood vessels, which may lead to scarring and retinal detachment.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a disorder of the developing retina in premature infants that can lead to blindness if left untreated. It occurs when the retina is incompletely developed and blood vessels grow abnormally.
2) Risk factors include prematurity, low birth weight, excess oxygen exposure, and other medical complications. The pathogenesis involves abnormal vasoproliferation and retinal neovascularization due to disrupted retinal vascular development.
3) ROP is classified based on location within zones of the retina, stage of disease progression from mild to severe, and presence of "plus disease" indicating worse prognosis. Timely screening and treatment can
Retinopathy of prematurity is a disease of the developing retina which develops as a result of disruption of the internal milieu of the developing retina leading ultimately to retinal detachment and blindness.
This document discusses retinopathy of prematurity (ROP), including its causes, risk factors, screening recommendations, and treatment. ROP occurs when abnormal blood vessels grow in the retina of premature infants. Key points include: ROP screening is recommended for infants born before 34 weeks gestation or weighing less than 1750g; screening should begin between 3-4 weeks of life and continue until 44 weeks; laser photocoagulation or anti-VEGF treatment may be used depending on the severity and location of the ROP. Preventive measures include maintaining oxygen saturation between 88-92% and aggressive nutrition support for premature infants.
This document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is a retinal vascular disease primarily affecting premature infants, with major risk factors being prematurity, low birth weight, and high oxygen exposure.
- The pathogenesis involves initial injury disrupting normal angiogenesis, followed by abnormal new vessel growth that can lead to retinal detachment.
- ROP is classified based on location, severity stage (1-5), extent, and presence of plus disease. The ETROP study showed benefit of early treatment for high-risk prethreshold ROP.
- Screening and treatment guidelines are based on gestational age and risk factors to detect treatable ROP as early as possible,
Retinopathy of prematurity (ROP) is a proliferative retinopathy affecting premature infants exposed to high oxygen levels. It was first identified in 1942 and the term was coined in 1951. High oxygen is a major cause, with very low birth weight also a risk factor. The immature retina responds to high oxygen with vasoconstriction and vascular occlusion in primary stage, followed by neovascularization in secondary stage. The International Classification of ROP standardized terminology and staging in 1984. Screening guidelines recommend examinations starting at 31-33 weeks post-conception. Laser treatment is the standard therapy for threshold ROP. Recent studies explore anti-VEGF agents and dietary supplements to prevent ROP progression and vision loss
This document discusses retinopathy of prematurity (ROP), including its causes, classification system, risk factors, screening guidelines, and treatment options. ROP is a disease of the developing retina in premature infants that can lead to vision impairment. It progresses in two phases from abnormal vessel growth to retinal detachment. Treatment includes laser therapy or anti-VEGF injections to ablate the abnormal vessels. Screening guidelines are based on gestational age and birth weight to monitor disease progression and determine when treatment is needed.
Retinopathy of prematurity (ROP) is a retinal vascular disorder that primarily affects premature infants. It occurs when the retinal blood vessels in the eye are not fully developed. The summary describes the key stages and phases of ROP pathogenesis. Phase 1 involves an initial insult like hyperoxia or hypoxia that arrests retinal vascular development. Phase 2 involves neovascularization driven by hypoxic conditions in the avascular retina. Treatment includes laser photocoagulation or anti-VEGF injections to promote regression of abnormal blood vessels and prevent retinal detachment. Several clinical trials have found that early treatment of high-risk prethreshold ROP improves outcomes by reducing unfavorable anatomical and visual outcomes compared to conventional observation and treatment.
Retinopathy of prematurity (ROP) is a proliferative retinopathy that affects premature infants, especially those with very low birth weights who received supplemental oxygen. The incompletely developed retinal blood vessels of premature infants are susceptible to abnormal growth in response to high oxygen levels. ROP progresses through five stages, from early vascular changes to total retinal detachment. Staging is based on the zone of the retina involved and extent of abnormal blood vessel proliferation. Timely eye exams by an ophthalmologist starting at 4 weeks of age can detect ROP for potential laser or cryotherapy treatment to prevent vision loss.
Retinopathy of prematurity (ROP) is a disorder in premature infants where abnormal blood vessel growth occurs in the retina. The developing retina is susceptible after premature birth interrupts normal vessel development. Exposure to abnormal oxygen levels, either high or low, can further disrupt growth. ROP is evaluated based on location within the retina, severity of abnormal vessels, and presence of "plus disease". Screening allows early detection so treatment like laser ablation can be given if the disease reaches a threshold level with risk of vision loss. While ROP can cause complications like retinal detachment if untreated, screening and timely treatment helps prevent blindness.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a proliferative retinopathy affecting premature infants that can cause lifelong visual impairment.
2) The development of the retinal vasculature is disrupted in premature infants due to their early exposure to a hyperoxic extra-uterine environment.
3) Laser photocoagulation treatment is recommended for high-risk pre-threshold and threshold ROP to ablate the peripheral avascular retina and prevent retinal detachment and blindness.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that can affect premature infants. It occurs when the retina develops abnormally due to premature birth and exposure to high levels of oxygen. Babies born before 30 weeks gestation or weighing less than 1500g are screened for ROP. Treatment includes laser photocoagulation or cryotherapy for severe cases to promote normal retinal development. With improved neonatal care and oxygen monitoring, the incidence of ROP and associated blindness can be reduced.
This document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is a leading cause of preventable childhood blindness, especially in middle-income countries. It affects the developing retinal vasculature of extremely preterm infants.
- Risk factors include low birth weight, prematurity, oxygen use, sepsis, and intraventricular hemorrhage. The pathogenesis involves abnormal retinal vascular growth due to premature birth.
- Screening all infants with a birth weight less than 1500g or gestational age less than 32 weeks is essential for early diagnosis and treatment to prevent retinal detachment and vision loss. Treatment includes laser photocoagulation or anti-VEGF therapy.
Retinopathy of prematurity (ROP) is a developmental vascular disorder of the retina that occurs in preterm infants. The retina is incompletely vascularized at birth for infants born before 30 weeks gestation. Premature birth interrupts normal retinal vascularization, exposing the retina to abnormal oxygen levels. This can cause vasoconstriction and arrest of blood vessel growth. Later, abnormal neovascularization may develop, potentially leading to retinal detachment and blindness if not treated. Screening guidelines recommend examinations starting at 4 weeks of age for infants born before 30 weeks, with treatment indicated for "threshold" or "pre-threshold" ROP. Laser photocoagulation is the primary treatment, which ablates the av
Retinopathy of prematurity (ROP) is a retinal vascular disease that affects premature infants. It occurs when the retina of premature infants is exposed to high concentrations of oxygen, causing abnormal blood vessel growth. ROP is staged based on the severity and location of the disease, and may progress to retinal detachment if not treated. Treatment options include laser photocoagulation, cryotherapy, or anti-VEGF injections to promote normal blood vessel growth and prevent further progression. Regular screening is important for monitoring ROP and detecting complications in older children.
Retinopathy of Prematurity (ROP) - classification and treatmentsAniruddha Rode
Informative presentation about retinopathy of prematurity.
For ophthalmologists and retina surgeons.
an attempt to give relevant information at a glance. latest trends and techniques of management.
Hope it will be helpful. Thanks.
Retinopathy of prematurity by dr. tareq rahmantareq rahman
Retinopathy of prematurity (ROP) is a retinal vascular disorder that occurs primarily in preterm infants. It develops due to interrupted retinal vascularization and abnormal blood vessel growth caused by premature birth. Infants with very low birth weight (<1500g) or gestational age (<32 weeks) are most at risk. If left untreated, ROP can cause blindness or severe vision impairment. Screening, timely diagnosis, and treatment with laser photocoagulation or anti-VEGF injections can help prevent vision loss from ROP.
Retinopathy of prematurity (ROP) is a disease of the developing retina that results from interrupted development of retinal blood vessels. It is a leading cause of blindness in children. ROP was initially described in the 1940s and is associated with supplemental oxygen use in premature infants. The retina develops from the optic cup and retinal blood vessel growth occurs after birth. ROP occurs when normal vessel growth is disrupted, leading to abnormal neovascularization. Staging of ROP involves evaluating location, severity, extent, and presence of plus disease. Laser treatment is the standard therapy to promote vessel growth and prevent retinal detachment. Screening high-risk infants and timely treatment can help prevent vision loss from ROP.
This document discusses retinopathy of prematurity (ROP), a disorder in premature infants where abnormal blood vessel growth occurs in the retina. It begins with definitions and embryology of the retina and retinal vasculature. Key points include that the retina remains avascular until the 4th month of gestation, and develops its mature vascular pattern by 5 months after birth. The document then covers the historical perspectives of ROP, pathogenesis involving oxygen and growth factors, classification system involving zones/stages/plus disease, risk factors like low birth weight and oxygen therapy, and recent advances.
Retinopathy of prematurity (ROP) is a developmental retinal vascular disorder that primarily affects premature infants. It occurs when the retina is incompletely vascularized. ROP was first described in 1941 and is a leading cause of childhood blindness. Infants born prematurely, with low birth weight, or who receive supplemental oxygen are at highest risk. The retina is normally vascularized after birth, and ROP results from interrupted vascularization. It progresses in two phases and can lead to retinal scarring and detachment if untreated. Screening, classification, treatment and monitoring guidelines aim to prevent vision loss from ROP.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a disorder of the developing retina in premature infants that can lead to blindness if left untreated. It occurs when the retina is incompletely developed and blood vessels grow abnormally.
2) Risk factors include prematurity, low birth weight, excess oxygen exposure, and other medical complications. The pathogenesis involves abnormal vasoproliferation and retinal neovascularization due to disrupted retinal vascular development.
3) ROP is classified based on location within zones of the retina, stage of disease progression from mild to severe, and presence of "plus disease" indicating worse prognosis. Timely screening and treatment can
Retinopathy of prematurity is a disease of the developing retina which develops as a result of disruption of the internal milieu of the developing retina leading ultimately to retinal detachment and blindness.
This document discusses retinopathy of prematurity (ROP), including its causes, risk factors, screening recommendations, and treatment. ROP occurs when abnormal blood vessels grow in the retina of premature infants. Key points include: ROP screening is recommended for infants born before 34 weeks gestation or weighing less than 1750g; screening should begin between 3-4 weeks of life and continue until 44 weeks; laser photocoagulation or anti-VEGF treatment may be used depending on the severity and location of the ROP. Preventive measures include maintaining oxygen saturation between 88-92% and aggressive nutrition support for premature infants.
This document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is a retinal vascular disease primarily affecting premature infants, with major risk factors being prematurity, low birth weight, and high oxygen exposure.
- The pathogenesis involves initial injury disrupting normal angiogenesis, followed by abnormal new vessel growth that can lead to retinal detachment.
- ROP is classified based on location, severity stage (1-5), extent, and presence of plus disease. The ETROP study showed benefit of early treatment for high-risk prethreshold ROP.
- Screening and treatment guidelines are based on gestational age and risk factors to detect treatable ROP as early as possible,
Retinopathy of prematurity (ROP) is a proliferative retinopathy affecting premature infants exposed to high oxygen levels. It was first identified in 1942 and the term was coined in 1951. High oxygen is a major cause, with very low birth weight also a risk factor. The immature retina responds to high oxygen with vasoconstriction and vascular occlusion in primary stage, followed by neovascularization in secondary stage. The International Classification of ROP standardized terminology and staging in 1984. Screening guidelines recommend examinations starting at 31-33 weeks post-conception. Laser treatment is the standard therapy for threshold ROP. Recent studies explore anti-VEGF agents and dietary supplements to prevent ROP progression and vision loss
This document discusses retinopathy of prematurity (ROP), including its causes, classification system, risk factors, screening guidelines, and treatment options. ROP is a disease of the developing retina in premature infants that can lead to vision impairment. It progresses in two phases from abnormal vessel growth to retinal detachment. Treatment includes laser therapy or anti-VEGF injections to ablate the abnormal vessels. Screening guidelines are based on gestational age and birth weight to monitor disease progression and determine when treatment is needed.
Retinopathy of prematurity (ROP) is a retinal vascular disorder that primarily affects premature infants. It occurs when the retinal blood vessels in the eye are not fully developed. The summary describes the key stages and phases of ROP pathogenesis. Phase 1 involves an initial insult like hyperoxia or hypoxia that arrests retinal vascular development. Phase 2 involves neovascularization driven by hypoxic conditions in the avascular retina. Treatment includes laser photocoagulation or anti-VEGF injections to promote regression of abnormal blood vessels and prevent retinal detachment. Several clinical trials have found that early treatment of high-risk prethreshold ROP improves outcomes by reducing unfavorable anatomical and visual outcomes compared to conventional observation and treatment.
Retinopathy of prematurity (ROP) is a proliferative retinopathy that affects premature infants, especially those with very low birth weights who received supplemental oxygen. The incompletely developed retinal blood vessels of premature infants are susceptible to abnormal growth in response to high oxygen levels. ROP progresses through five stages, from early vascular changes to total retinal detachment. Staging is based on the zone of the retina involved and extent of abnormal blood vessel proliferation. Timely eye exams by an ophthalmologist starting at 4 weeks of age can detect ROP for potential laser or cryotherapy treatment to prevent vision loss.
Retinopathy of prematurity (ROP) is a disorder in premature infants where abnormal blood vessel growth occurs in the retina. The developing retina is susceptible after premature birth interrupts normal vessel development. Exposure to abnormal oxygen levels, either high or low, can further disrupt growth. ROP is evaluated based on location within the retina, severity of abnormal vessels, and presence of "plus disease". Screening allows early detection so treatment like laser ablation can be given if the disease reaches a threshold level with risk of vision loss. While ROP can cause complications like retinal detachment if untreated, screening and timely treatment helps prevent blindness.
This document provides an overview of retinopathy of prematurity (ROP), including:
1) ROP is a proliferative retinopathy affecting premature infants that can cause lifelong visual impairment.
2) The development of the retinal vasculature is disrupted in premature infants due to their early exposure to a hyperoxic extra-uterine environment.
3) Laser photocoagulation treatment is recommended for high-risk pre-threshold and threshold ROP to ablate the peripheral avascular retina and prevent retinal detachment and blindness.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that can affect premature infants. It occurs when the retina develops abnormally due to premature birth and exposure to high levels of oxygen. Babies born before 30 weeks gestation or weighing less than 1500g are screened for ROP. Treatment includes laser photocoagulation or cryotherapy for severe cases to promote normal retinal development. With improved neonatal care and oxygen monitoring, the incidence of ROP and associated blindness can be reduced.
This document provides an overview of retinopathy of prematurity (ROP), including:
- ROP is a leading cause of preventable childhood blindness, especially in middle-income countries. It affects the developing retinal vasculature of extremely preterm infants.
- Risk factors include low birth weight, prematurity, oxygen use, sepsis, and intraventricular hemorrhage. The pathogenesis involves abnormal retinal vascular growth due to premature birth.
- Screening all infants with a birth weight less than 1500g or gestational age less than 32 weeks is essential for early diagnosis and treatment to prevent retinal detachment and vision loss. Treatment includes laser photocoagulation or anti-VEGF therapy.
Retinopathy of prematurity (ROP) is a developmental vascular disorder of the retina that occurs in preterm infants. The retina is incompletely vascularized at birth for infants born before 30 weeks gestation. Premature birth interrupts normal retinal vascularization, exposing the retina to abnormal oxygen levels. This can cause vasoconstriction and arrest of blood vessel growth. Later, abnormal neovascularization may develop, potentially leading to retinal detachment and blindness if not treated. Screening guidelines recommend examinations starting at 4 weeks of age for infants born before 30 weeks, with treatment indicated for "threshold" or "pre-threshold" ROP. Laser photocoagulation is the primary treatment, which ablates the av
Retinopathy of prematurity (ROP) is a retinal vascular disease that affects premature infants. It occurs when the retina of premature infants is exposed to high concentrations of oxygen, causing abnormal blood vessel growth. ROP is staged based on the severity and location of the disease, and may progress to retinal detachment if not treated. Treatment options include laser photocoagulation, cryotherapy, or anti-VEGF injections to promote normal blood vessel growth and prevent further progression. Regular screening is important for monitoring ROP and detecting complications in older children.
Retinopathy of Prematurity (ROP) - classification and treatmentsAniruddha Rode
Informative presentation about retinopathy of prematurity.
For ophthalmologists and retina surgeons.
an attempt to give relevant information at a glance. latest trends and techniques of management.
Hope it will be helpful. Thanks.
Retinopathy of prematurity by dr. tareq rahmantareq rahman
Retinopathy of prematurity (ROP) is a retinal vascular disorder that occurs primarily in preterm infants. It develops due to interrupted retinal vascularization and abnormal blood vessel growth caused by premature birth. Infants with very low birth weight (<1500g) or gestational age (<32 weeks) are most at risk. If left untreated, ROP can cause blindness or severe vision impairment. Screening, timely diagnosis, and treatment with laser photocoagulation or anti-VEGF injections can help prevent vision loss from ROP.
Retinopathy of prematurity (ROP) is a disease of the developing retina that results from interrupted development of retinal blood vessels. It is a leading cause of blindness in children. ROP was initially described in the 1940s and is associated with supplemental oxygen use in premature infants. The retina develops from the optic cup and retinal blood vessel growth occurs after birth. ROP occurs when normal vessel growth is disrupted, leading to abnormal neovascularization. Staging of ROP involves evaluating location, severity, extent, and presence of plus disease. Laser treatment is the standard therapy to promote vessel growth and prevent retinal detachment. Screening high-risk infants and timely treatment can help prevent vision loss from ROP.
This document discusses retinopathy of prematurity (ROP), a disorder in premature infants where abnormal blood vessel growth occurs in the retina. It begins with definitions and embryology of the retina and retinal vasculature. Key points include that the retina remains avascular until the 4th month of gestation, and develops its mature vascular pattern by 5 months after birth. The document then covers the historical perspectives of ROP, pathogenesis involving oxygen and growth factors, classification system involving zones/stages/plus disease, risk factors like low birth weight and oxygen therapy, and recent advances.
Retinopathy of prematurity (ROP) is a developmental retinal vascular disorder that primarily affects premature infants. It occurs when the retina is incompletely vascularized. ROP was first described in 1941 and is a leading cause of childhood blindness. Infants born prematurely, with low birth weight, or who receive supplemental oxygen are at highest risk. The retina is normally vascularized after birth, and ROP results from interrupted vascularization. It progresses in two phases and can lead to retinal scarring and detachment if untreated. Screening, classification, treatment and monitoring guidelines aim to prevent vision loss from ROP.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Light House Retreats: Plant Medicine Retreat Europe
ROP_Dr. Pradeep Bastola.pptx
1. Retinopathy of Prematurity (ROP)
Retrolental fibroplasia
Terry’s Disease
Dr. Pradeep Bastola, MBBS, MD, MPH
Chitwan Medical College, Nepal
2. References
• American Academy of Ophthalmology
• Wolff’s Ocular Anatomy
• Myrin Yanoff
• Ryan’s Retina 5th Edition
• Clinical Ophthalmology by Jack J. Kanski
• The Massachusetts Eye and Ear
Infirmary Illustrated Manual of
Ophthalmology
• AIOS Ready Reckoner in Ophthalmology
• Duke Elder Book of Ophthalmology
• Various articles from Internet
• Presentations of Dr. Pradeep Bastola
3. Background
Retinopathy of Prematurity (ROP) is a serious vasoproliferative disorder that
affects extremely premature infants.
Milder forms of ROP often regress or heal.
ROP remains a serious problem despite striking advances, and is one of the
most important causes of childhood blindness and disability.
It can lead to lifelong disabilities for the smallest survivors of neonatal intensive
care unit (ICU).
4. History, and Overview
• Initially described as retrolental fibroplasia by Terry in 1942, ROP was the leading cause of
preventable blindness in children in the United States (US, 1940s – 50s).
• Three "epidemics" of blindness due to ROP have been described, the first epidemic
occurred in the 1940s-1950s in industrialized countries primarily due to unmonitored
supplemental oxygen.
• Regulation and monitoring of high oxygen at birth caused ROP to virtually disappear, but
as a result of advances in neonatal care, premature infants survived at earlier gestational
ages and lower birth weights, and ROP re-emerged to be a serious problem, leading to the
second epidemic that began in the 1970s in industrialized countries.
5. • In the mid-1990s, the third epidemic began in low- and middle-income countries
due to both high rates of preterm birth and varying levels of neonatal care in these
countries (some countries/regions within countries lack the technology and
resources to optimize their care) where ROP is seen in larger and older infants
exposed to unregulated oxygen (similar to that in the US of 1940s and 50s)
• In the US and developed countries, ROP affects extremely premature infants and involves
incomplete vascularization of the retina as well as oxygen-induced damage, which is
believed to play less a role now.
8. Etiology
• In utero, the fetus is in a hypoxic state in contrast to after birth. When infants are born
prematurely, the relative oxygen level is increased sometimes even when oxygenation
is at ambient level.
• High supplemental oxygen can be damaging to capillaries.
• The cause of ROP is premature birth and additional factors that cause a mismatch
between normal retinal vascularization and oxygen need by the developing retina.
9. ROP Risk Factors
Low birthweight
Young gestational age
High, unregulated oxygen at birth, fluctuations in
oxygenation
Poor postnatal growth
Intraventricular hemorrhage
Respiratory distress syndrome (RDS)
• Sepsis
• White race
• Blood transfusion
• Multiple births
• Hypocalcaemia
• Patent Ductus Arteriosus
• Small for Age
The youngest, sickest, and smallest baby is at the highest risk of developing ROP
10. Pathophysiology
The smallest, sickest, and most immature infants are at the highest risk for
serious disease. Race is also a factor: Black infants appear to have less severe
ROP.
Retinal vasculature begins to develop around 16 weeks' gestation. It extends
from the optic nerve head centrifugally toward the periphery. Full vascular
maturation of the retina typically occurs near term (40 weeks).
Premature birth results in a disruption of normal retinal vascular maturation.
Exposure of newborn premature infants to hyperoxia downregulates retinal
vascular endothelial growth factor (VEGF).
11. • Exposure of new-born premature infants to hyperoxia downregulates retinal vascular
endothelial growth factor (VEGF).
• Blood vessels constrict and can become obliterated, resulting in delays of normal retinal
vascular development.
• This hyperoxia vaso-cessation results in avascular peripheral retina, and it is seen
clinically as stage 0 or stage 1 of retinopathy of prematurity.
• Vascular Endothelial Growth Factor (VEGF), and Insulin like Growth Factor (IGF) play
important role in ROP.
12. Epidemiology
1. The incidence of retinopathy of prematurity (ROP) varies with birth
weight, but it is reported to be approximately 50-70% in infants
whose weight is less than 1250 g at birth (In the US).
2. In an unpublished report on ROP, Bastola et al. found a
prevalence/Incidence of ROP in 62% preterm babies with risks in
neonatal intensive care units (NICU) of Central India.
3. In CMC, six pre-term babies examined ROP is yet to be diagnosed.
4. A Korean study reported a 20.7% incidence whereas, a study from
Singapore reported a 29.2% incidence of ROP
13. Race-, sex-, and age-related demographics
• No sexual predilection
• Black infants less likely to develop severe ROP
• Importantly, ROP is a disease of the immature retina, and the occurrence
of ROP is inversely related to gestational age.
• Generally, infants born at 32 weeks or greater have an extremely low risk
of ROP.
• EBLW infants, especially those with a more unstable clinical course (more
comorbidities), are more likely to develop and require treatment for ROP.
14. Physical Examination
Screening (Primary prevention)
An ophthalmologist experienced in evaluating infants for retinopathy of prematurity
(ROP) should perform a screening examination.
International classification
• To standardize examinations, a group of physicians organized an international
classification of ROP (ICROP) in 1984 and updated the classification in 1987 and 2005.
• ROP is characterized by three parameters: stage, zone, and plus disease (i.e, tortuosity
of vessels).
15. Whom to screen for ROP?
• The American Academy of Pediatrics (AAP) and the American Academy of
Ophthalmology (AAO) have joint recommendations for infants who should be
screened for ROP.
• However, in India, Nepal, and rest of South East Asian Region, screening for ROP
should be initiated in babies born below 34 weeks of gestation, and or less than
2000 Grams, or new born babies who have had an extensive treatment in the
hospital for various conditions, and as per the opinion of the neonatologist
regarding the risks.
16. The following infants should be screened for ROP (The United States of
America) - Guidelines
• Low birthweight (1500 grams or less)
• Gestational age (30 weeks or less)
• 1500 grams < birthweight < 2000g grams or gestational age > 30 weeks who
are believed by their pediatrician or neonatologist to be at risk for ROP (e.g.,
history of hypotension requiring inotropic support, received supplemental
oxygen for more than a few days or without oxygen saturation monitoring)
17. Gestational Age at Birth Postmenstrual age (PMA) (weeks) Chronologic (weeks)
22 weeks 31
9, consider earlier screening per clinical
judgment
23 weeks 31
8, consider earlier screening per clinical
judgment
24 weeks 31 7
25 weeks 31 6
26 weeks 31 5
27 weeks 31 4
28 weeks 32 4
29 weeks 33 4
30 weeks 34 4
>30 weeks with high risk factors - 4
18. • This guideline should be considered tentative rather than evidence-based for infants with a GA of 22-23
weeks because of the small number of survivors in these categories.
• Follow-up examinations are based on initial examination findings.
• Most infants are screened every 2 weeks. More frequent (once a week or less) follow-up is recommended
in stage 1 or 2 ROP in zone I and in stage 3 ROP in zone II.
• The presence of plus disease requires careful evaluation because, in these cases, peripheral ablation is
more appropriate rather than observation alone.
• Screening examinations are continued until the blood vessels reach the anterior edge of the retina (complete
retinal vascularization around 40 weeks' gestation) or until postmenstrual age of 45 weeks with no
prethreshold disease (defined as stage 3 ROP in zone II, any ROP in zone I) or no worse ROP is present.
19. Location (Zone)
Zone I: The area defined by a circle centered on optic nerve, the radius of which extends from the center of the optic
disc to twice the distance from the center of the optic disc to the centre of the macula.
Zone II: The area extending centrifugally from the edge of zone I to a circle with a radius equal to the distance from the
center of the optic disc to the nasal ora serrata.
Posterior Zone II: A region of 2 disc diameters peripheral to the zone I border
Zone III: The residual temporal crescent of retina anterior to zone II. By convention, zones II and III are considered to be
mutually exclusive.
Zone is based on the most posterior zone (as the retina may be vascularized to different extents in different regions of
the retina, i.e. nasal vs temporal vs superior vs inferior)
The term "notch" is "an incursion by the ROP lesion of 1 to 2 clock hours along the horizontal meridian into a more
posterior zone than the remainder of the retinopathy.
If present, it should be documented by the most posterior zone with the qualifier "secondary to notch."
20.
21. Staging (International Classification of ROP – ICROP)
• Stage I is characterized by a
line of demarcation between
the vascular and avascular
retina. Branching or
arborization can be seen
growing at the leading edge
of the retinal vasculature.
22. Stage II
• Ridge formation at the demarcation line area, flat neovascularization
may be present behind the ridge.
• Popcorn lesion may be seen
23. Stage III
• Extra-retinal neovascularization, and or vessels that grow off the ridge towards
the vitreous or the examiner.
24. Stage IV
Stage IV – A: Partial Retinal (Sub-total) Detachment not involving the
macula
Stage IV – B: Partial Retinal (Sub total) Detachment involving the macula
25. Stage V (Retrolental fibroplasia)
Total Retinal Detachment (Funnel Shaped RD): Retinal detachments are generally
tractional and usually funnel shaped. The configuration of the funnel itself is used
for subdivision of this stage depending on if the anterior and posterior portions are
open or narrowed.
Stage 5 is into 3 configurations (ICROP3): Stage 5A: the optic disc is visible by
ophthalmoscopy, stage 5B: the optic disc is not visible secondary to retrolental
fibrovascular tissue or closed-funnel detachment, and stage 5C: where the
"findings of stage 5B are accompanied by anterior segment abnormalities
26. Extent
• The extent of disease is recorded as hours of the clock or as 30° sectors. As the
observer looks at each eye, the 3-o’clock position is to the right and nasal in the right
eye and temporal in the left eye, and the 9-o’clock position is to the left and temporal
in the right eye and nasal in the left eye.
• Extent is useful in Stages 4 and 5 ROP but, in general, is no longer necessary in the
diagnosis of treatment-warranted (type 1) ROP.
27. Plus disease
Additional signs of increased venous dilatation and arteriolar tortuosity of the
posterior retinal vessels which can increase in severity to include iris vascular
engorgement, poor pupillary dilatation, and vitreous is referred as plus disease in the
original classification.
28. Pre-Plus Disease
Pre-plus disease is defined as vascular abnormalities of the posterior pole that are
insufficient for the diagnosis of plus disease but that demonstrate more arterial
tortuosity OR more venous dilatation than normal.
29. Aggressive ROP (A-ROP)/APROP
• Previously, aggressive posterior ROP (AP-ROP) was recognized as an uncommon,
rapidly progressing, severe form of ROP and added to the revisited international
classification in 2005.
• Characteristic features of this type of ROP are a posterior location (Zone I or
posterior zone II), plus disease, and the ill-defined nature of the retinopathy, which
usually progresses to stage 5 if untreated.
• This rapidly progressing type of ROP has also been referred to as "Rush disease".
• There are vascular loops and no obvious demarcation line or ridge.
• Fundus fluorescein angiography may delineate the vascular changes more clearly in
this disease
30. Regression
• With the most recent International Classification of Retinopathy of Prematurity, 3rd
edition (ICROP3), the term regression was introduced, which refers to disease
involution and resolution. Regression may be complete or incomplete, including
persistence of retinal abnormalities.
• Signs of vascular regression include decreased plus disease, vascularization into the
peripheral avascular retina, involution of the tunica vasculosa lentos, better
pupillary dilation, greater media clarity, and resolution of Intraretinal hemorrhages.
Regression of ROP is characterized by thinning and whitening of neovascular tissue.
Hybrid Disease: Plus disease, AROP/APROP plus Ridge formation
31. Diagnosis
• Installation of Tropicamide 0.5% + Phenyl Ephrine 2.5% (Mydriatic eye drops) at least three times, 15
minutes apart to dilate the pupil.
• Indirect Ophthalmoscopy with scleral indentation till the ora is visualized both nasally, and temporally.
• RetCam to stage, and classify ROP for the record, and take photographs for future follow ups in
needed cases.
• All the instruments used in Indirect Ophthalmoscopy should be sterile, and one set is used for one
baby only.
• Be cautious about cardio-respiratory distress in the newborn babies (Inform neonatologist or
pediatrician on the day of examination), use lowest dose minimum to avoid complications.
32. Management
• Recommended follow up in 1 week or less
• Zone I: stage 0 (immature vascularization), 1, or 2 ROP
• Posterior Zone II: immature vascularization
• suspected presence of AP-ROP
• Recommended follow up in 1-2 weeks
• Zone I: unequivocally regressing ROP
• Posterior Zone II: immature vascularization
• Zone II: stage 2 ROP
33. • Recommended follow up in 2 weeks
• Zone II: Stage 0 (immature vascularization) or 1, or unequivocally
regressing ROP
• Recommended follow up in 2-3 weeks
• Zone II: regressing ROP
• Zone III: stage 1 or 2 ROP
34. Termination of Screening is done when,
• Retinal is fully vascularized
• Zone III retinal vascularization without previous ROP in Zone I or II (may need a confirmatory exam if
PMA <35 weeks)
• PMA = 45 weeks and no type 2 ROP (i.e. "prethreshold disease" (defined as stage 3 ROP in zone II, any
ROP in zone I) or worse ROP)
• If previously treated with anti-VEGF (vascular endothelial growth factor) injection, follow until at least
PMA = 65 weeks (FYI: infant needs close follow up during time of highest risk for disease reactivation
PMA: 45-55 weeks)
• ROP has fully regressed (ensure there is no abnormal vascular tissue present that can reactivate and
progress)
35. Long-term follow up
After termination of acute retinal screening.
Prematurely-born infants should be seen within 4-6 months after
discharge from the NICU because they are at increased risk for
developing strabismus, amblyopia, high refractive error, cataract, and
glaucoma.
36. Surgery/Treatment
Cryoablation was first used to treat as designated by the CRYO- ROP study in 1986
• Threshold ROP is defined as 5 contiguous or 8 cumulative clock hours of stage 3 ROP in
zone 1 or zone 2 with plus disease.
• Subsequently, argon and diode lasers have been used similarly to treat the avascular
retina to reduce unfavourable outcomes.
• Laser units are preferred because they are more portable and better tolerated by
patients.
• Currently ROP treatment guidelines are based on the Early Treatment of Retinopathy
of Prematurity Study (ETROP).
37. Laser/Anti VEGF treatment is currently recommended for the following
(defined as "type 1" ROP)
• Zone I: any stage ROP with plus disease
• Zone I: stage 3 ROP without plus disease
• Zone II: stage 2 or 3 ROP with plus disease
Eyes meeting these criteria should be treated as soon as possible, at least within 72 hours.
The number of clock hours of disease is no longer a determining factor for treatment.
38. Anti-VEGF treatment has shown promise (compared to conventional laser therapy) for
treatment of stage 3 ROP with plus disease in Zone I (not Zone II).
Recent clinical studies and trials have been performed to test de-escalating doses of
bevacizumab (reduced from the BEAT-ROP study) or ranibizumab in the RAINBOW
study for type 1 (i.e. treatment-warranted) ROP.
Both studies have found efficacy with lower bevacizumab doses or with ranibizumab 0.2
mg in treatment-warranted ROP.
Treatment with aflibercept has also been found to be beneficial.
39. Follow-up is recommended in 3-7 days following laser photocoagulation or anti-VEGF
injection.
Surgically treated eyes must be watched carefully for regression and reactivation.
Very late recurrences of proliferative ROP have been reported following anti-VEGF
therapy.
40. Complications
Late complications of ROP include
myopia, amblyopia, strabismus,
nystagmus, cataracts, retinal
breaks, and retinal detachment.
Follow-up by an Ophthalmologist
is required on a long-term basis
41. Prognosis
• The prognosis of retinopathy of prematurity (ROP) is predicted by the disease stage.
• Patients who did not progress beyond stage 1 or stage 2 have a good prognosis, as do
most successfully treated babies with zone II/III disease.
• Patients with posterior zone I disease or stage 4 have a guarded prognosis for their
vision.
• Infants with stage 5 disease mostly have extremely poor vision.
• Infants with advanced ROP may develop vision threatening conditions such as myopia,
amblyopia, and strabismus
42. Additional References, and further reading
• Chiang MF, Quinn GE, Fielder AR, Ostmo SR, Paul Chan RV, Berrocal A, Binenbaum G, Blair M, Peter Campbell J, Capone A Jr, Chen
Y, Dai S, Ells A, Fleck BW, Good WV, Elizabeth Hartnett M, Holmstrom G, Kusaka S, Kychenthal A, Lepore D, Lorenz B, Martinez-
Castellanos MA, Özdek Ş, Ademola-Popoola D, Reynolds JD, Shah PK, Shapiro M, Stahl A, Toth C, Vinekar A, Visser L, Wallace DK,
Wu WC, Zhao P, Zin A. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021
Oct;128(10):e51-e68. doi: 10.1016/j.ophtha.2021.05.031. Epub 2021 Jul 8. PMID: 34247850.
• Palmer EA, Hardy RJ, Dobson V, Phelps DL, Quinn GE, Summers CG, Krom CP, Tung B; Cryotherapy for Retinopathy of Prematurity
Cooperative Group. 15-year outcomes following threshold retinopathy of prematurity: final results from the multicenter trial of
cryotherapy for retinopathy of prematurity. Arch Ophthalmol. 2005 Mar;123(3):311-8.
• https://eyewiki.aao.org/Retinopathy_of_Prematurity
• https://emedicine.medscape.com/article/976220-overview
• Boyd K, Janigian RH. Retinopathy of Prematurity. American Academy of Ophthalmology. EyeSmart® Eye health.
https://www.aao.org/eye-health/diseases/retinopathy-of-prematurity-list. Accessed March 25, 2019.