retinopathy of prematurity

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PowerPoint Presentation:

Retinopathy of prematurity ( Classification and screening) Krushna Gopal Panda

PowerPoint Presentation:

International classification of Retinopathy of prematurity(ICROP)

Zone I:

Zone I Circle with radius twice the distance between disc and fovea Macula I II III Optic disc 3 12 6 9 I 9 12 3 6 Ora serrata I II III

Zone II:

Zone II Macula I II III Optic disc 3 12 6 9 I 9 12 3 6 Ora serrata I II III From the edge of zone I to equator temporally and ora serrata nasally

Zone III:

Zone III Macula I II III Optic disc 3 12 6 9 I 9 12 3 6 Ora serrata I II III From zone II to the ora serrata temporally

Extent of the disease:

Extent of the disease Macula I II III Optic disc 3 12 6 9 I 9 12 3 6 Ora serrata I II III 1-12 Clock hours Contiguous or non-contiguous

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Stage 1:Demarcation line Classification of ROP – Staging

Stage 2 - Ridge :

Stage 2 - Ridge

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Stage 3 : Extra retinal fibro vascular proliferation

Stage 4 A : Extra macular TRD:

Stage 4 A : Extra macular TRD

Stage 4B – TRD involving macula:

Stage 4B – TRD involving macula

Stage 5 : Total RD:

Stage 5 : Total RD

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More ROP terminology

Plus disease:

Plus disease Dialatation & tortuousity of posterior pole retinal vessels Engorgement & dilatation of iris vessels Poor pupillary dilatation Vitreous haze

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Pre plus disease Vascular abnormalities of posterior pole insufficient for diagnosis of plus disease Demonstrate more arterial tortuosity and venous dilatation than normal May proceed to plus disease

Threshold ROP:

Threshold ROP stage 3 in Zone I or Zone II + >5 contiguous or 8 non contiguous clock hours + plus component

Pre-threshold ROP:

Pre-threshold ROP Zone 1, stage 3 with/without plus disease Zone II stage 3, < 5 contiguous or 8 non contiguous clock hours or Zone II stage 3, 5 contiguous or 8 non contiguous clock hours with plus

Rush Disease:

Rush Disease Severe plus disease + Zone I ROP Progresses rapidly in days Needs very aggressive treatment Out come - comparatively poor

Aggressive Posterior ROP (AP-ROP) :

Aggressive Posterior ROP (AP-ROP) shunt vessel avascular retina

The most important step in management of ROP:

The most important step in management of ROP Screening

Screening for ROP:

Screening for ROP Why ????

Whom to screen ?:

Whom to screen ? Birth weight < 1900grams GA ≤ 35 weeks Blood transfusion, RDS, Pneumonia, Extra ordinary oxygen support, Sepsis, multiple birth, Intra ventricular heamorrhage

When to screen ?:

When to screen ? Within 30 days of life preferably between 2- 4 weeks after birth Within 20 days of birth for very preterm babies If there is a problem in calculating PCA then follow the LMP , EDD

Where to screen ?:

Where to screen ?

How to perform the screening:

How to perform the screening Preparation of the child Instruments Procedure

Aims of screening:

Aims of screening To assess whether baby has the disease at a treatable stage or not

Post screening measures:

Post screening measures Mature retina – Review 3 monthly till 1 yr Immature retina in Zone 1 – weekly review Immature retina in Zone 2 – once in 2 week Threshold/High risk prethreshold – Laser within 24 -48 hrs Stage 4 & 5 - surgery