Retinopathy prematurity (ROP) is a blinding disease in premature babies caused by the formation of abnormal blood vessels in the developing retina. (the eye’s innermost light-sensitive layer).
In a full-term baby, blood vessels grow along the surface of the developing retina until they terminate. Premature birth causes incomplete growth and abnormal vessel growth. These abnormal blood vessels are delicate and easily bleed. Scarring can occur as a result of repeated bleeding. As the scar tissue contracts, it pulls on the developing retina, causing retinal detachment.
ROP is asymptomatic. Blindness in an infant is often not recognized by parents until the child is 6-8 months old, or even later. Thus, screening is critical for premature babies.
Less severe forms of ROP may be associated with:
ROP is classified into five stages of increasing severity. Stages 1 and 2 may regress from time to time. Treatment is usually required in stage 3 (sight-threatening ROP). Stages 4 and 5 are the most severe and, despite treatment, often result in poor visual outcomes. Plus disease denotes a more severe ROP.
From the inside out, the infant retina is divided into three zones, with Zone 1 being the most critical for vision, Zone 2 requiring treatment in stages 3 and beyond, and Zone 3 disease typically requiring no treatment.
Laser photocoagulation is the mainstay of ROP treatment. ROP treatment is required for stages 3 and above. Stages 4 and 5 require surgery, either scleral buckling or vitrectomy. Anti-VEGF agents may be given in select cases of Zone 1 disease, particularly in very sick babies who cannot tolerate laser photocoagulation.
Babies born before 34 weeks and weighing less than 2 kg should be screened for ROP within the first 28 days of life. This is usually performed by a trained ophthalmologist. Serial examinations are performed at weekly or biweekly intervals until the growth is complete or to detect if sight-threatening ROP is developing.
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