Retinopathy of Prematurity (ROP)

Retinopathy of Prematurity (ROP) - What it is

Retinopathy of Prematurity (ROP) is due to an abnormal growth of blood vessels in the baby's eye. It is most common in babies who are very premature. In the baby’s development, blood vessels grow from the back of the eye out towards the edges. This process is completed just a few weeks before the normal time of delivery. In premature babies, this process is not complete. If blood vessel grows normally, the baby does not develop ROP. If the vessels grow and branch abnormally, the baby has ROP

Retinopathy of Prematurity (ROP) - Symptoms

There are no symptoms of ROP. Infants, especially premature ones, must be screened by an ophthalmologist to diagnose the condition and manage it subsequently.

Retinopathy of Prematurity (ROP) - How to prevent?

The best way to prevent ROP is to avoid premature birth. Other measures include close monitoring of oxygen needs in premature babies. The baby should also have regular screening examinations of the eyes by an ophthalmologist, especially if he or she has a high risk of ROP.

Retinopathy of Prematurity (ROP) - Causes and Risk Factors

Premature babies who are born under 30 to 33 weeks of gestation are at higher risk of developing ROP than babies at over 34 weeks gestation. Exposure to high concentration of oxygen in the first few weeks of life, prolonged periods of fluctuations in oxygen saturations or a multi- systemic illness in a preterm baby may increase the risk of developing ROP.

Retinopathy of Prematurity (ROP) - Diagnosis

If a baby is at risk of ROP, an ophthalmologist will check the baby’s eyes. The babies who are at risk and hence screened for ROP are clearly defined in the Departmental guidelines on ROP.

These tests start at about four to six weeks of age and happen regularly until the eye vessels have grown to the edges.

If the ophthalmologist sees any abnormal growth of blood vessels, he or she will record the extent of ROP, called Staging. Infants who have ROP need more frequent eye tests to watch for progress of the condition.

Retinopathy of Prematurity (ROP) - Treatments

Treatment of ROP lowers the chance of blindness, but it does not always prevent it.

The treatment depends on the stage of the blood vessel growth. In Stage I and early Stage II, treatment is usually not needed. These stages may resolve by themselves without further growth of the abnormal vessels. Infants with Stage III may require treatment to stop the growth of abnormal vessels.

To treat ROP, the inner lining of the eye at the ends of these vessels is prevent from abnormally growing by the use of laser therapy which causes a diminished blood supply and prevents the inner lining (retina) from being pulled away from the outer lining (detached) by the abnormal vessels. It is the treatment of choice as it is less invasive and less discomforting to the baby and is quite effective to stop progression of the ROP. However in up to 15% of babies, this may not halt disease progression and more invasive surgical treatments (scleral buckling, vitrectomy) may have to be considered.

The Ophthalmologist might also consider the use of ANTI-VEGF (a growth factor thought to promote ROP) is some instances. This is injected into the main chamber of the eye under aseptic precautions and under local anaesthesia.

Retinopathy of Prematurity (ROP) - Preparing for surgery

Parents must be informed and consent obtained if any of the above treatments are considered for ROP. The details of the procedure will be explained to Parents fully by the Ophthalmologist, Anaesthetist and the Neonatal team.

All preparations are carried out include pre-operative investigations as necessary. The baby is intubated and sedated whilst laser treatment or other more invasive surgery is performed and all monitoring of vital signs and precautions are undertaken during and after the intervention.

Retinopathy of Prematurity (ROP) - Post-surgery care

Following surgery, the baby is managed in the NICU and receives standard post-operative eye care and follow up as per existing guidelines and protocols .The baby will continued to be followed up by the Ophthalmologists following discharge from Hospital as long as is necessary.

Retinopathy of Prematurity (ROP) - Other Information

Overview

Lazy Eye (Amblyopia)

Article contributed by Neonatal ＆ Developmental Medicine, Singapore General Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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