retinopathy of prematurity

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Retinopathy of prematurity : 

Retinopathy of prematurity

Anatomy of Eye : 

Anatomy of Eye

Slide 3: 

Rods and Cones Rods: Specialized receptors for dim light Grey Tones Cones: Only function under high light Color receptors

Slide 4: 

Vision

Slide 5: 

Definition Risk factors Pathogenesis Epidemiology Clinical picture & complication Classification Diagnosis Treatment prevention objectives

Retinopathy of Prematurity (ROP) : 

Retinopathy of Prematurity (ROP) previously known as Retrolental Fibroplasia

Retinopathy of Prematurity (ROP) : 

Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. that occurs when abnormal blood vessels grow and spread throughout the retina, These abnormal blood vessels are fragile and can bleed leading to retinal scarring and/or retinal detachment.

Risk factors : 

Risk factors Prematurity (All babies <1500 g birth weight or younger than 32 weeks' Gestational Age at birth are at risk of developing ROP). High levels of supplemental oxygen Mechanical ventilation Multiple blood transfusions Intraventicular hemorrhage .

Risk factors : 

Risk factors Concurrent illnesses Anemia Seizures & Apnea Multiple prenatal maternal factors including, diabetes, preeclampsia ,heavy smoking. Genetic polymorphism !!!

Pathogenesis : 

Pathogenesis Exposure to hyperoxic extrauterine conditions, develop gap junctions. These gap junctions interfere with the normal vascular formation, triggering a neovascular response. 2 phases 1st phase hyperoxic retinal VC & irreversible capillary endothelial destruction2nd phase ischemia trigger angiogenic factors (VEGF). Genetic polymorphism !!!

History & Epidemiology : 

History & Epidemiology

incidence of ROP : 

incidence of ROP It is more frequent in : white infants > black infants male infants > female infants. International Unknown United States 51% of infants weighing less than 1700 g noted development of ROP ,and about 10% of the infants develop stage 3 ROP.

incidence of ROP : 

incidence of ROP In the UK In 1985-1990 ROP-induced complete or partial blindness constituted around 5-8% of childhood vision impairment and was confined mainly to babies below 1000g. The incidence had decreased to 3% in 2000.

Clinical manifestations : 

Clinical manifestations Asymptomatic White pupils (Leukocoria) Abnormal eye movements (Nystagmus) Crossed eyes (Strabismus) Severe nearsightedness (Myopia)

Complications : 

Complications Loss of vision even with aggressive surgical treatment Amblyopia due to high refractive errors Strabismus Glaucoma Retinal detachment Blindness

Diffrentional diagnosis : 

Diffrentional diagnosis Retinoblastoma Familial exudative vitreoretinopathy (FEVR) Primary hyperplastic primary vitreous (PHPV)

INTERNATIONAL CLASSIFICATION OF ROP : 

INTERNATIONAL CLASSIFICATION OF ROP

The severity of ROP : 

The severity of ROP (a) stages (b) extent (c) anatomical location (d) presence or absence of plus disease

Stage 1 : 

Stage 1 Demarcation Line A line that is seen at the edge of vessels, dividing the vascular from the avascular retina. Retinal blood vessels fail to reach the retinal periphery and multiply abnormally where they end .

Stage 2 : 

Stage 2 Ridge The line structure of stage 1 acquires a volume to form a ridge with height and width.

Stage 3 : 

Stage 3 Ridge with extra-retinal fibrovascular proliferation The ridge of stage 2 develops more volume and there is fibrovascular proliferation into the vitreous.

Stage 4 : 

Stage 4 Partially detached retina. Traction from the scar produced by bleeding, abnormal vessels pulls the retina away from the wall of the eye.

Stage 5 : 

Stage 5 Completely detached retina and the end stage of the disease. If the eye is left alone at this stage, the baby can have severe visual impairment and even blindness.

Plus disease : 

Plus disease It means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease. Treatment at this point has a good chance of preventing retinal detachment.

location & Extent : 

location & Extent

Diagnosis : 

Diagnosis The fundus examined by indirect ophthalmoscope, or wide field digital fundus photography with a specially adapted camera (Ret Cam). after dilating a pupil.

screening : 

screening If the baby is born at 23-24 weeks' GA, the first eye examination should be performed at 27-28 weeks GA. If the baby is born at or beyond 25-28 weeks' GA, the first examination should occur at the fourth to fifth week of life. Beyond 29 weeks, the first eye examination should probably occur before the child is discharged.

Treatment of Active ROP : 

Treatment of Active ROP Stage 1&2 Most babies who develop ROP stages I or II regresses without major complications. Stage 3 If the baby has stage 3 retinopathy and fulfils the criteria for treatment ( 5 contiguous or 8 non contiguous clock hours of stage 3 with plus disease in zone I or II. ), laser treatment will be given.

Treatment of Active ROP : 

Treatment of Active ROP stage 4 & 5 In the later stages of ROP ( stage 4 & 5 ), other treatment options rather than laser & cry therapy include: Scleral buckle Vitrectomy

Prevention : 

Prevention good prenatal care is essential to prevent ROP prenatally & postnatally . Careful monitoring of oxygen therapy in NICU Screening of premature babies by ophthalmologist is essential in lessening the advancement of ROP. Patient Education ophthalmology consultation is essential in a premature infant.

summary : 

summary Retinopathy of prematurity (ROP) , previously known as Retrolental Fibroplasia . a disease that affect developing retinal vascular system of premature babies. The risk of disease is inversely related to gestational age & birth weight . ROP is one of the few largely preventable causes of childhood vision impairment . Its incidence is related to quality of neonatal intensive care unit services & referral consultation .

Thanks very much : 

Thanks very much DR. ZENAB M. TAMER