Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is an eye disorder that occurs in premature infants born before 31 weeks of gestation, with a full-term pregnancy typically lasting about 38 to 42 weeks. This condition affects the retina, the light-sensing tissue at the rear of the eye responsible for transmitting visual signals to the brain. In cases of ROP, unwanted blood vessels develop on the infant’s retina, potentially leading to significant eye and vision complications in the future.

While ROP might resolve as the infant matures, consistent monitoring by an ophthalmologist is crucial throughout their growth. In certain instances, immediate intervention may be necessary to avert potential blindness. Without timely treatment, the child could face profound and permanent vision impairment, potentially resulting in total blindness.

Stages of Retinopathy
of Prematurity

ROP has five distinct stages that doctors use to gauge its severity, ranging from stage 1 (mild) to stage 5 (severe):

Stages 1 and 2: Infants within these stages often experience improvement without intervention and maintain healthy vision. Medical professionals closely monitor these babies to assess potential progression of ROP.
Stage 3: While some infants with stage 3 ROP recover without treatment and sustain good vision, others require intervention to prevent abnormal blood vessels from harming the retina and leading to retinal detachment, a condition associated with vision loss.
Stage 4: Babies in stage 4 exhibit partial retinal detachment and necessitate treatment.
Stage 5: Stage 5 denotes complete retinal detachment. Even with intervention, infants in this stage may encounter vision loss or blindness.

Both stages 4 and 5 are particularly critical. Babies in these stages typically require surgical procedures; however, even with treatment, vision loss remains a possibility. Consequently, doctors often commence treatment at stage 3.

It’s important to note that any stage can swiftly deteriorate, requiring immediate treatment. Consistent adherence to follow-up examinations is crucial to promptly detect and address ROP. Timely identification and management of ROP offer the best chance of mitigating potential serious complications.

 

Symptoms of Retinopathy
of Prematurity

Visible signs of ROP are absent. In advanced stages of ROP, the retina might undergo partial or complete displacement from its customary position at the rear of the eye, a condition known as retinal detachment. This detachment can lead to vision impairment and eventual blindness.

If your baby experienced ROP that resulted in damage, you might eventually observe the following indicators:

  • Erratic eye movements, tremors, or unusual motions
  • Inability of their eyes to track objects 
  • Whitened appearance of their pupils
  • Difficulties recognizing faces

Moreover, infants who previously suffered from ROP are at an elevated risk of encountering additional eye issues as they age, which can encompass:

  • Retinal detachment
  • Nearsightedness
  • Amblyopia (lazy eye)
  • Strabismus (crossed eyes)

If your child had ROP during infancy, it is imperative to prioritize regular checkups and eye examinations. Early detection and management of potential eye problems are crucial for safeguarding your child’s vision as they grow older.

Causes of Retinopathy
of Prematurity

The final stages of blood vessel development in the eyes generally conclude a few weeks before birth. An infant born prematurely is exposed to a range of factors that could influence this process. Factors such as medication administration, oxygen supplementation, intense light exposure, or rapid temperature fluctuations could impact the development of the eye’s blood vessels.

Listed below are elements that medical professionals believe could contribute to the development of ROP:

1. Low birth weight, typically around 3 pounds or less.
2. The extent of prematurity. An infant born at 28 weeks of gestation is at a higher risk of ROP compared to one born at 32 weeks.
3. The administration of supplemental oxygen to the infant after birth.
4. Ethnicity also plays a role, as White babies are more susceptible to ROP compared to Black babies. Moreover, premature infants with other health issues, such as anemia (low iron levels in the blood), insufficient vitamin E, or respiratory difficulties, have an elevated risk of developing ROP.

Diagnostics of Retinopathy
of Prematurity

In the immediate aftermath of birth, every premature infant should undergo an assessment for retinopathy of prematurity (ROP). During the hospital stay, an ophthalmologist can evaluate the baby’s eyes. Nonetheless, the visibility of ROP symptoms might be delayed until several weeks post-birth. Consequently, premature infants prone to ROP typically receive ophthalmologist evaluations between 4 to 6 weeks after birth and continue with periodic assessments.

Attending all scheduled follow-up appointments with the ophthalmologist is crucial. Early identification and intervention can play a pivotal role in averting enduring vision impairment.

Complications of Retinopathy
of Prematurity

Complication of Retinopathy of Prematurity encompass a range of issues such as nearsightedness, premature cataract formation, neovascularization of the iris, glaucoma, retinal pigmentation, retinal folding, retinal dragging, lattice-like degeneration, retinal tears, as well as rhegmatogenous and exudative retinal detachments.

Treatment of Retinopathy
of Prematurity

ROP can vary in severity, ranging from self-correcting cases to those requiring surgical intervention due to the possibility of severe scarring that can lead to retinal detachment and subsequent vision loss or blindness. Surgical treatment for ROP is aimed at halting the growth of abnormal blood vessels, focusing on preserving the central retina’s functionality by addressing the peripheral retina. This entails creating scars on the peripheral retina to arrest aberrant growth and alleviate retinal pulling. While peripheral vision loss may occur due to the surgery’s emphasis on the peripheral retina, the preservation of central retina function enables vital tasks such as direct gaze, color differentiation, and reading.

The two primary methods for ROP surgery are:

  • Laser surgery (photocoagulation): Utilizing focused laser beams to scar the peripheral retina, this method is commonly employed for ROP treatment.
  • Injections: A medicine is injected into the eye as an alternative to or in conjunction with laser surgery. This newer approach often facilitates more normal blood vessel growth, with ongoing research to assess its long-term effects on premature infants.

For advanced ROP cases accompanied by retinal detachment, the following techniques are employed:

  • Scleral buckling: A flexible silicone band encircles the eye, pushing the detached retina closer to the eye’s outer wall by causing the sclera to buckle.
  • Vitrectomy: This procedure replaces the eye’s clear gel (vitreous) with a saline solution, facilitating the surgeon’s removal of scar tissue and reducing retinal tension to prevent detachment.