Retinopathy of prematurity (ROP) is a disorder of the developing retina in premature infants. It is a major cause of childhood blindness worldwide. ROP occurs in two phases - an initial hypoxic phase followed by a second hyperoxic phase driven by abnormal blood vessel growth. The International Classification of ROP (ICROP) provides a standardized system to classify ROP based on location, stage of severity, and presence of plus disease. Screening guidelines recommend examining infants born before 31 weeks gestation or weighing less than 1500g to detect ROP early and prevent vision loss. Treatment options include laser photocoagulation, anti-VEGF injections, or surgery depending on the stage of ROP.
A Clinical Case wherein patient presented with signs & symptoms of Fanconi Syndrome, on further evaluating the history; it was found that he matched the clinical criteria for Lowe Syndrome
A Clinical Case wherein patient presented with signs & symptoms of Fanconi Syndrome, on further evaluating the history; it was found that he matched the clinical criteria for Lowe Syndrome
Retinopathy Of Prematurity.By Cynthia Oloo JKUAT student Bsc comprehensive op...CYNTHIAANYANGOOLOO
early treatment and prevention of retinopathy of prematurity occuring in premature born <34 weeks and with increase supplementation of oxygen and any other neonates with respiratory or cardiac diseases
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
1. PRESENTER- DR. SHILPA HEDAOO
DNB OPHTHALMOLOGY
CIVIL HOSPITAL FARIDABAD
Retionopathy of prematurity
2. DEFINITION
• Retinopathy of prematurity (ROP) of developing retinal
vasculature is multifactorial vasoproliferative retinal
disorder is a disorder of premature,LBW infants featuring
abnormal proliferation of developing blood vessels at the
junction of vascular and the avascular retina
Prevalence:
• 65% of newborns with B.wt <1,250g and
• 80% of newborns with a B.wt <1,000 g will develop some
degree of ROP
3. NORMALRETINALVASCULATUREDEVELOPMENT
• The first blood supply to the inner retina appears as “spindle cells
from the adventitia of the hyaloids artery at about 16wks of GA.
Spindle cells canalize and metamorphose into mature vessels.
and reach the nasal ora serrata
• 16 weeks Retinal vessels arise from hyaloid vessels at optic
disc and begin to migrate outwards
• 36 weeks Migration is complete on nasal side
• 40 weeks Migration is complete on temporal side
• Before the retinal vessels develop the avascular retina receives
oxygen by diffusion from the choroid vessels.It achieves the adult
pattern by the 5th month after birth.
5. PATHOphysiology of rop
1. The classical theory- proposed by arthon and patz
2. Spindle cell theory-proposed by Kretzer et al
3. The current theory/recent theory-experimental and clinical
evidence suggest that disease proceeds in 2
phasesfluctuations in retinal oxynation.
PHASE 1 of ROP begins from birth (before approx. 31wks of
GA)
PHASE 2 of ROP begins over the ensuing weeks (by 32-
34wks of GA)
6. Stage I
• Hypoxia
• Hypotension
Stage I
• Vasoconstriction and decreased blood flow to
developing retina
• Arrest of vascular development
Stage I
• Hypoxia causes down regulation of
harmones /growth factor(VEGF) cessation
of VEGF driven vessel growth and vaso- obliteration
of parts of retinal vasculature by vascular
endothelial cells apoptosis and excessive capillary
regression with retinal ischemia
IN PHASE 1 ROP
7. Stage II
• Stage of Neovascularization
• Hypoxic avascular retina upregulates
VEGF/IGF-1
Stage II
• Aberrant retinal vessels growth in to retina and
vitreous
• More permeable Hemorrhage and edema
Stage II
• Extensive extraretinal fribrovascular proliferation
Retinal detachment and abnormal retinal function
• Most infants its mild and regresses spontaneously
IN PHASE 2 ROP which is hypoxic driven
8. RECENT ADVANCES IN PATHOphysiology-
1. ROLE OF OXYGEN FREE RADICALS IN ROP-The balance
between the production and catabolism of oxygen metabolites is
essential in maintaining normal physiological conditions-
Increased level of superoxide in the retina under hyperoxic
conditions.
2. Insulin like Growth Factor – lack of insulin-like growth factor I
(IGF-I) in knockout mice prevents normal retinal vascular
growth
3. Granulocyte Colony–Stimulating Factor
4. Jun Kinases (Jnk) Inhibitors
9. CLASSIFICATION– ICROP
The International Classification of Retinopathy of Prematurity
(ICROP1) was published in 1984 under the leadership of John
Flynn later expanded in 1987.
ICROP was revised in 2005 (ICROP2)by adding:
1) The concept of a more virulent form of retinopathy –
APROP (Aggressive posterior Retinopathy of
Prematurity).
2) Description of an intermediate level of vascular dilatation and
tortuosity of posterior pole vessels that are insufficient for the
diagnosis of plus disease(i.e.Pre-plus disease)
10. MOST RECENTLY IN 2021( ICROP3)
retains current definition such as ZONE,STAGE and CIRCUMFERENTIAL
EXTENT OF DISEASE
Major updates in ICROP3 include refined classification metric
1. Posterior zone II
2. Notch
3. Subcategarization of stage 5(5A, 5B, 5C)
4. Recognition that a continuous spectrum of vascular abnormalities exists
from normal to plus disease
5. Replace AP-ROP to Aggressive ROP(may occurs beyond the posterior
retina
6. Detail description of ROP Regression and Reactivation
7. Description of long term sequelae
11. The original ICROP requires 4 defining concepts for ROP
1. ANTERIOR-POSTERIOR LOCATION or ZONE of involvement
2. EXTENT of disease(measured in clock hours0
3. SEVERITY or STAGING OF ROP
4. Presence or absence of PLUS DISEASE(dilatation and tortuosity
of vessels in ZONE 1)
12. CLASSIFICATION – ICROP
I-ANTERIOR-POSTERIOR LOCATION/ZONE
• ZONE I:
▫ Centre: Optic disc
▫ Radius: 2 x Disc-foveal distance
▫ Boundaries: Completely surrounded by Zone II
• ZONE II:
▫ Centre: Optic disc
▫ Radius: Distance from optic disc to nasal ora-serrata
▫ Boundaries: Inner-Zone I, Outer-Zone-III temporally
• ZONE III:
▫ a crescent-shaped retinal area extending beyond
zone-II to the temporal ora-serrata
13.
14. ICROP3 UPDATE
POSTERIOR ZONE II-ICROP3 defined a region that
begins at the margin between Zone I and Zone II for 2
disc diameters peripheral to zone border.Indicates
more worrisome disease than ROP
NOTCH-an incursion by the ROP lesion of 1-2clock
hours along the horizontal meridian into the more
posterior zone(e.g “zone I secondary to Notch”)
15.
16. III-EXTENT
Number of clock hours of ROP along the circumference of the
vascularized retina(from 1-12)
No longer used for treatment decisions
17. II SEVERITY – STAGING OF ROP
STAGE-0 :Immature retinal vasculature without pathological changes
STAGE-1: DEMARCATION LINE: a flat, thin, white demarcation line
between the vascularized and the avascular retina. The vessels end abruptly
at the demarcation line with no vessels extending beyond it
18. STAGE 2- a demarcation line with height,width, and
volume(RIDGE); small, isolated tufts of neovascular tissue lying
on the surface of the retina commonly called popcorn may be
seen posterior to ridge.
19. STAGE 3 –
• External fibrovascular proliferation
or neovascularization that extends
from the ridge into the vitreous.
The severity of the lesion can be
subdivided into-
1. Mild- presence of only limited
amount of vascular tissue.
2. Moderate: Significance amount
tissue infiltrating into the vitreous.
3. Severe: massive infiltration of
tissue surrounding the ridge is
seen.
20. STAGE 4- a partial retinal detachment
• 4a – Extra foveal partial retinal detachment (RD)
• 4b – Partial RD involving the fovea
21. STAGE -5 – Total retinal detachment –currently classified by
configuration of the funnel(ICROP3)
• Open-Open(a)
• Open-closed(b)
• Closed-open(C)
• Closed-closed(d)
22. STAGE -5 – Total retinal detachment
Subcategarised into 3 configuration
A. Optic nerve head is visible by
ophthalmoscopy(open funnel
detachment).
B. Optic nerve head is not visible by
ophthalmoscopy due to retrolental
fibrosis or (closed funnel
detachment).
C. 5B with anterior segment
abnormalities (e.g.Anterior les
displacement, marked AC
shallowing, central CO,iridocapsular
adhesion, capsule-endothelial
adhesion).
23. Icrop3update
Stage of Acute Disease(Stage1-3)- is defined by the
appearance of the structure at the vascular and avascular
junction as Stage1(demarcation line), Stage2 (Ridge),
and Stage3 (Extraretinal neovascular proliferation or flat
neovascularisation)
•Retinal detachment (Stages 4 and 5)
•Subcategarization of stage 5(5A, 5B, 5C)
24.
25. • PLUS DISEASE:used to indicate abnormal vascular
dilatation(venous) and tortuosity(arteriolar) of posterior pole
vessels in at least 2 quadrants (usually 6 or more clock hours)
of the eye;iris vascular dilatation and vitreous haze may be
present.
• PRE-PLUS DISEASE:recent classification uses thus term to
describe eyes Abnormal vascular dilation and tortuosity that is
insufficient for diagnosis of plus disease
IV-POSTERIOR POLE VASCULAR
ABNORMALITIES
26. AGGRESSIVE ROP
Earlier known as ‘RUSH Disease’ and ‘(AP-ROP)
Aggressive posterior ROP’
A rapidly progressive, severe form of ROP often but not
always Posterior location
• Rapidly evolving pre-plus and plus disease
neovascularization that may be subtle or even
intraretinal in nature, sometimes iris rubeosis:
the peripheral retinopathymay be ill defined
• Progress to stage IV & V in 2-3 weeks without passing
through characteristic stages II and III
28. • Threshold ROP:
▫ ≥ 5 contiguous clock-hour Or 8 cumulative clock hours (30-
degree sectors) of extraretinal neovascularization location at
Zone 1 Or 2 with plus disease
• Pre-Threshold ROP:
▫ Type 1
• 🞄
zone I, any ROP and plus disease or
• Zone I, stage 3 without plus disease or
• 🞄
zone II, stage 2 or 3 ROP with plus disease
▫ Type 2
• 🞄
In zone 1, stage 1 or 2 ROP, without plus disease
• 🞄
In zone 2, stage 3 ROP without plus disease
As an extension of these concepts further classify ROP can help
to optimize management and treatment.
30. • The procedure is performed at NICU by pediatric
opthalmologist , under the supervision of neonatologist so
that complication can be handled.
• The pupil are dilated with a mixture of phenyl phrine 2.5%
and tropicamide 0.4 % or cyclopentolate 0.5% instilled 3
times at 10min intervals before the scheduled examination.
• Topical anesthetic and lid speculum should be used to
reduce discomfort.
• Indirect opthalmoscopy is performed with 20D / 30D lens
using fresh sterile instruments.
• Scleral depression is done to stabalize the eye , rotate it ,
indent it.
• RETCAM can be used to provide real time video display of
images
SCREENINGPROCEDURE
31. SCREENING OF ROP(KIDROP)
The need for a ROP screening program arises from the fact that
• ROP is a blinding disease
• Identification of all babies is essential who are at risk or likely to get severe
ROP
• Timely and early detection prevents undesirable sequel and
progression to advanced stages
Current guidelines for screening- by American Academy of
Ophthalmology
1. Infants with birth weight of less than 1500g or GA of 32Wks or less
2. Infants with birth weight between 1500g to 2000g /GA > 32Wks with
unstable clinical course, including those requiring cardio-respiratory
support.
32. • Wide angle digital paediatric
retinal imaging system
• Mobile, self contained system for
use in nursery, ICU, O.T
• Easily used by technicians or
nurses
• Provide retinal images at 130
degree
• Avoids stress & expertise of I/O
examination & indentation, but as
specific and sensitive as I/O
• Useful for diagnosis,
telemedicine &
documentation
33. SCREENINGINTERVAL
A) FOLLOW-UP IN 1-WEEK OR LESS
•Immature vascularisation: zone I—no ROP
•Immature retina extends into posterior zone II, near the boundary of
zone I
•Stage 1 or 2 ROP in zone I
•Stage 3 ROP in zone II
• the presence or suspected presence of aggressive posterior ROP
B) FOLLOW-UP IN 1- TO 2-WEEK
•Immature vascularisation; posterior zone II
•Stage 2 ROP in zone II,
•Unequivocally regressing ROP in zone I
34. C) FOLLOW-UP IN 2-WEEK
•Stage 1 ROP in zone II,
•Immature vascularisation: zone II—no ROP,
•Unequivocally regressing ROP in zone II
D) FOLLOW-UP IN 2- TO 3-WEEK
• Stage 1 or 2 ROP in zone III,
• Regressing ROP in zone III
35. • COMPLETE VASCULARIZATION
• VASCULARIZATION in ZONE III (till 1 DD of temporal
ora) – if no previous ROP in zone I & II
• REGRESSED ROP ( b/w 40 -44 weeks PCA)– no active
disease left
• 45 weeks PCA with less than pre threshold disease
TERMINATIONOF SCREENING
39. • Mostly outdated
• Firstly used by hindle and leyton
• Rationale- elimination of production of vasoproliferative
factor
produced by avascular retina
• Indications-
CRYOTHERAPY
40. LASER PHOTOCOAGULATION THERAPY
According to ETROP study, current indications for laser
treatment are high risk ROP-
1) Zone I, stages 1-3 ROP with plus disease
2) Zone I, stage 3 ROP without plus disease
3) Zone II, stage 2 or 3 ROP with plus disease
• In the past decade, laser photoablation has almost
supplanted cryotherapy as the standard treatment for ROP.
• Procedure of choice,less invasive, less traumatic and causes
less discomfort to the infant.
• Compared to cryotherapy, laser photoablation better structural
and visual outcomes, fewer post-operative complications and
less myopia.
▫
41. • Laser treatment is delivered through an indirect
opthalmoscope .
• It can be performed in NICU and under local
anesthesia
• Easy to treat posterior located lesion.
• Argon green and Diode red LASER has been used
• An average of 1000 to 2000 spots of 100 mm size 1½ burn
width apart can be placed in each eye.
• Entire avascular retina till ora, avoid the ridge.
• End point – grade II gray burn
42. • ⦿ Monotherapy
• Single injections
• Multiple injections for recurrence
• Less desirable if periphery not perfused
• ⦿Adjunctive therapy
• Injections to allow regression beyond Zone 1
• Laser for recurrent ROP
• Anti-VEGF as a Bridge to laser peripherally
• Treatment after laser / cryotherapy failure
• ⦿ Perioperative therapy before surgery
• Reduce bleeding
• Promote regression of neovascularization
• Vitrectomy and scleral buckles
ANTIVEGF
43. • GOAL- increase likelihood and vision of each patient
• Pathophysiologically – proliferation of epiretinalglial cells in stage
4/5 ROP,the membranes exert traction and lead to retinal
detachment
• Once the macula detaches in stage 4b or 5 ROP retinal
reattachment is done.
SURGERY
44.
45. SCLERAL BUCKLE
• done for progressive stage 4a and 4b
• It is done under GA
• Peritomy 2.5 mm encircling band passed beneath 4 recti
• One anchoring mattress 4-0 ethibond suture applied in all
quadrants, final knot in temporal quadrant( easy removal)
• Removal after 3-6 months
46. VITRECTOMY
• INDICATIONS- detachment in stage 4b/5 too severe to be
relieved by scleral buckling alone, recent rapid progression
to detachment, extensive total RD
• Treat pupillary block glaucoma and corneal edema
before sx
• GOAL- complete release of preretinal tissue with
release of traction
• Approach- closed and open sky
47. TECHNIQUE
• Peritomy, infusion canula 1-1.5 mm from limbus
• Standrad pars ciliaris entry to avoid subretinal entry of
instruments
• Lensectomy done only when required
• Multiple radial incisions made in retrolental plane
towards equitorial area, creating stellate appearance
• Delamination and peeling of membranes- cut as closely
as possible to retina
• SRF drainge- usually not necessary (
non rhegmatogenous)
COMPLICATIONS-
• Iatrogenic retinal breaks, haemmorhage, corneal clouding
48. Icrop3update
Regression- Definition of ROP regression and its sequelae,
whether spontaneous or after laser or Anti-VEGF treatment.
Regression can be complete or incomplete. Location and extend
of peripheral avascular retina (PAR) should be documented
Reactivation- Definition and description of ROP reactivation after
Treatment include new ROP lesions and vascular changes.When it
Occurs, the modifier reactivated(e.g., “reactivation Stage2) is
Recommended.
49. LONGTERM sequelae
Emphasized beyond previous version of ICROP,including such
as
• Late retinal detachment
• Retinoschisis
• PAR (persistant avascular retina)-prone to retinal
thinning,holes,lattice like changes
• Macular Anomalies-small FAZ, blurring/absence of foveal
depression
• Retinal vascular changes-persistent tortuosity,
straightening of vascular arcade with macular dragging and
falciform retinal fold. Vitreous haemorrhage may occur.
• Glaucoma-secondary angle closure glaucoma