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BHARTI AHUJA
INTRODUCTION
Proliferativeretinopathy affecting premature infants of low
birth weight and young gestational age(Terry,1942).
Term was coined by HEATH(1951).
BIRTHWEIGHT
GESTATIONAL AGE
OXYGEN SUPPLEMENTATION
Risk factors(associated)
Prematurity
Hyper/hypoxia
Hypotension
Acidosis
Blood transfusions
Sepsis
Antioxidant deficiency
Apnoea
PDA
Vitamin E deficiency
JOURNAL OF AAPOS,AUG 2009,VOL 13 ISSUE 4, pg 370-73
RONALD G.W.TEED,RICHARD A. SAUNDERS
Retinopathy of prematurity in extremely premature infants
Introduction
The incidence and severity of retinopathy of prematurity (ROP) in
extremely premature infants have not been reported since publication of
the Early Treatment of ROP study results. The survival rate of these
infants continues to increase. We sought to determine the characteristics
of ROP in a group of surviving infants <25 weeks estimated gestational
age (EGA) at birth compared to a group 25 to 27 weeks EGA at birth.
Methods
Conclusions
Extremely premature infants are more likely to develop
ROP and type 1 ROP, but the incidence may be lower than
previously reported. Birth weight may not influence the
incidence of type 1 ROP in this group of infants. Type 1
ROP does not develop at an earlier postmenstrual age in
the extremely premature infant
Pathogenesis of ROP
PHASE I PHASE II
STAGE 1-5
EXTENT IN
LOCATION
CLOCK
ZONES I-III
HOURS
ICROP STAGING
ROP: STAGES DESCRIPTION
STAGE 1
STAGE 2 Demarcation line
STAGE 3 MILD/MODERATE/ Ridge
SEVERE
Ridge with extraretinal
STAGE4 fibrovascular
A proliferation
B Subtotal retinal
STAGE 5 detachment
A.Not involving macula
B.Involving macula
Total retinal detachment
STAGE 1
STAGE 3
STAGE 4B
STAGE 4A
Funnel shaped
RD(STAGE 5)
Open opeop
Retrolental fibroplasia
Conclusion:
When used in a routine ROP screening setting, a
randomised comparison of WFDRI and BIO, WFDRI showed
relatively poor sensitivity in detecting mild forms of ROP in
the retinal periphery. This resulted in difficulty in making
decisions to discharge infants from the screening
programme. Sensitivity was better for more severe forms
of ROP, but at present WFDRI should be regarded as an
adjunct to, rather than a replacement for, BIO in routine
ROP screening.
AMERICAN JOURNAL OF OPHTHALMOLOGY JULY 2009, VOL 148,ISSUE
1,pg 136
SPEED OF TELEMEDICINE VS OPHTHALMOSCOPY FOR DIAGNOSIS OF RO
CONCLUSION:
The ophthalmologist time requirement for telemedical ROP diagnosis
is significantly less than that for ophthalmoscopic diagnosis.
Additional time requirements associated with bedside ROP diagnosis
increased this disparity. Telemedicine has potential to alleviate the
time commitment for ophthalmologists who manage ROP
Treatment
options(available)
Ablative therapy(cryotherapy and laser)
Scleral buckling surgery
Lens sparing vitrectomy
Lensectomy +vitrectomy
Open sky vitrectomy
Anti VEGF injections(controversial)
Guidelines for treatment of
ROP(Ablative therapy)
Stage 1 or 2 ,progressing to stage 3
All stage 4a cases
Extraretinal fibrovascular proliferation
present in more than 3contiguous or 5
cumulative clock hours in zone 1/2
Presence of plus disease
Comparison of ablative
therapy
Cryotherapy Laser
Yang CS, Wang AG, Sung CS, Hsu WM, Lee FL, Lee SM.
Purpose
To assess the long-term visual outcomes and refractive status in patients
with diode laser-treated threshold retinopathy of prematurity (ROP), and to
investigate the causes of impaired visual function
Method
A total of 60 eyes of 30 consecutive patients with diode laser-treated
threshold ROP were recalled for assessment at the age of 7 years or more.
Results
There were 38 eyes (65.5%) achieving 6/12 or better vision, however, an
unfavourable visual outcome (6/60 or worse) occurred in four eyes (6.9%). One
eye (1.7%) had unfavourable structural outcome. Of these 60 laser-treated eyes,
46 eyes (77.0%) were myopic, the overall mean spherical equivalent was -3.87
D. Anisometropia (>/=1.5 D) was also noted in 14 patients (46.7%). Strabismus
was present in nine patients (30.0%). Perinatal neurological events of
intraventricular haemorrhage (IVH) were identified in eight children (26.7%),
periventricular leucomalacia (PVL) in eight children (26.7%), and cerebral palsy
(CP) in four children (13.3%). There was a statistically significant association of
the presence of strabismus with PVL (P=0.002). The presence of anisometropia
was a significant risk factor associated with poor visual outcome of 6/15 or worse
in laser-treated ROP (P=0.002)
Conclusion
The majority of patients with diode laser-treated threshold ROP had favourable
anatomical and visual outcomes. However, anisometropia, advanced refractive
error, strabismus, and perinatal neurological events remain important causes of
impaired visual function. Long-term follow-up is very important for early
detection and timely treatment of these ocular morbidities.
Indian J Ophthalmol. 2009 Jul-Aug;57(4):267-71
To assess the functional and visual outcomes after primary lens-sparing pars
plana vitrectomy for Stage 4 ROP.
CONCLUSION
Lens-sparing vitrectomy helps to achieve a favorable anatomical and
functional outcome in selected cases of Stage 4 ROP.
ONLINE JOURNAL OF
OPHTHALMOLOGY,2009,OCTOBER
CONCLUSIONS:
Early vitrectomy that removes vitreous gel from around the proliferative
tissue promptly reduces vascular activity and may limit progression of
retinal detachment in APROP.
BRITISH JOURNAL OF OPHTHALMOLOGY,92, 2008,PG 1450-55
Usually negative.
History of prematurity, low birth
Positive(25-30%cases,bilateral)
wt ,oxygen usage.
Usual time of presentation is 6-
Family history negative.
18 mths.
Leukocoria may be detected Unilateral usually.
after 6-8 wks.
Heterogenous mass with
Clinical findings bilateral.
haemorrhages,many vessels on
Leukocoria-fibrotic look,a ridge surface.
with cicatricial vessels in Calcification(large% of cases)
periphery.
Origin of mass from underlying
No significant lesion on X-ray.
retina.
B-scan-complex pattern of Calcification within the mass.
detachment.
CTscan-no specific pattern
Sequelae of ROP
Spontaneous regression
MYOPIA
STRABISMUS
AMBLYOPIA
CATARACT
GLAUCOMA
RETINAL BREAKS/DETACHMENT
AMERICAN JOURNAL OF OPHTHALMOLOGY APR 2009,VOL 147,
,ISSUE 4 pg-661-66
CONCLUSION:
The retina of eyes at stage 5 ROP is more vulnerable to a recurrence
of the RD than in eyes at stage 4B after being attached by vitrectomy.
The time of recurrence varies widely, and the presence of traction on
the peripheral retina may be a sign of a recurrence.
PREVENTION OF ROP
Judicious oxygen therapy
Judicious use of blood transfusions
Strict clinical and electronic monitoring
Vitamin E supplementation
Prenatal steroids
PROGNOSIS
Predicted by the stage of retinopathy of
prematurity.
Patients who did not progress
beyond stage I or stage II have a good
prognosis.
Patients with posterior zone I disease or
stage III, IV, or V have a guarded
prognosis for their vision.
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