What is Retinopathy of Prematurity(ROP)?
Retinopathy of prematurity (ROP) is a significant cause of avoidable childhood blindness in middle-income countries (Gilbert, 2008). This condition primarily affects infants born prematurely, specifically those born 4 or more weeks before their expected due date and who have undergone intensive neonatal care. ROP highlights the importance of early detection and appropriate management to prevent vision loss and ensure optimal eye health in these vulnerable infants.
Who is at risk for ROP?
Premature babies are in the number 1 risk group for retinopathy of prematurity. Generally, the smaller and more premature the infant, the more likely they are to develop ROP and the more likely to need treatment.
Low birthweight babies with a weight < 1.5 kg
Young gestational age of < 30 weeks
High, unregulated oxygen at birth
Poor postnatal growth
Anaemia, infection, transfusions, breathing difficulties, heart disease.
What Causes Retinopathy of Prematurity(ROP)?
ROP occurs when the eye’s blood vessels stop growing for a time, then begin growing abnormally and randomly.
The new vessels are fragile and can leak, leaving the retina scarred.
In the worst-case scenario, the retina detaches (tears away from the back wall of the eye) and puts the baby at high risk of becoming blind.
The early cut-off of chemicals that babies receive from their mother in the womb, including insulin-like growth factor I (IGF-I) and vascular endothelial growth factor (VEGF) is usually the case.
What are the Signs, Symptoms & Staging of ROP?
An infant with severe ROP might develop:
Nystagmus (abnormal eye movements)
Leukocoria (white pupils).
Strabismus (squint)
Stages of ROP include:
Stage 1:Demacration line
Stage 2:Ridge formation
Stage 3:- Ridge with extra retinal fibrovascular proliferation
Stage 4:Subtotal Retinal detachments
Stage 5:-Total retinal Detachment
How do we treat Retinopathy of Prematurity (ROP)?
We at Amita Eye Care Conduct ROP screening for all newborns and the vast majority of infants with ROP are analyzed through those exams.
Our highly trained Medical Retina Consultants and Surgeons who recognize and treat ROP can spot these signs, using special instruments to examine your child’s retina.
Screening is done after 1 month of birth of child (whichever is earlier)
Diagnosis of ROP is made by sequential examinations, indirect ophthalmoscopy, and digital imaging
Cryotherapy for Retinopathy of Prematurity
Laser photocoagulation is the preferred treatment of choice. Laser photocoagulation is performed when ROP reaches type 1 pre-threshold disease.
Anti-VEGF Injections: Intravitreal injections of anti-vascular endothelial growth factor (Anti-VEGF) may cause rapid resolution of aggressive posterior ROP. Failure of which can lead to Retinal Detachment.
Surgery: If laser or cryotherapy fails, and the patient develops a retinal detachment, vitrectomy, scleral buckling may be performed.
Follow-Up: Done every 2 weeks. Patients with a history of ROP have a higher incidence of astigmatism, high myopia, and retinal detachment and should be followed up routinely.