retinopathy of prematurity

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Retinopathy of PrematurityRetinopathy of Prematurity

Mohammed Nabil J AlAliMohammed Nabil J AlAli5th year medical studentAt King Faisal University

Group B (210006209)

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-Introduction -Epidemiology-Risk factors-Pathophysilogy

-ICROP-Prevention -Treatment-Prognosis


Introduction ( The Retina)


Cut-away of the human eye showing its essential parts.


Definition• Retinopathy of prematurity (ROP) was

formerly known as retrolental fibroplasia.

• Disorder of the developing retinal vasculature resulting from interruption of normal progression of newly forming retinal vessels.

• Occurs in the incompletely vascularized retina of primarily premature infants.

• ROP is one of the most common causes of blindness in children.


Epidemiology

• The overall incidence of ROP is 16-17% for all premature infants.

• In infants with birth weight below 1251 grams, the incidence is 66%


Risk Factors

Major risk factors Associated risk factors

•Decreased gestational age• Decreased birth weight•Supplemental oxygen therapy.

•Acidosis•Apnea•Patent Ductus arteriousus •Septicemia,•Blood transfusions•Intraventricular hemorrhage


Vascular Development of the Eye

Nasal side

Temporal side

Pathophysiology


Pathophysiology

• Not well understood but thought to involve two stages:– Stage I: an initial injury (such as hypotension, hypoxia, or

hyperoxia) causes vasoconstriction and reduced blood flow to the retina, disrupting the normal process of vascularization.

– Stage II: Vessels then either resume normal growth or new vessels grow abnormally out from the retina into the vitreous. The abnormal vessels have increased permeability which can result in edema and hemorrhage. Inflammation → fibrous tissue → traction on the retina and detachment. Alternatively, the abnormal vascularization may regress with little residual effect.

• Recently, the interaction between insulin-like growth factor-1 (IGF-1) and VEGF has been studied and proposed to play a role in the pathogenesis of ROP (Hellstrom et al. PNAS 2001; 98:5804).


Role of IGF-1 and VEGF in the pathogenesis of ROP

Fig. 5. Schematic representation of IGF-I/VEGF control of blood vessel development in ROP.

(Hellstrom et al. PNAS 2001; 98:5804)


AL Hassa


International Classification for Retinopathy of Prematurity (ICROP)

• Four features are evaluated:– Zone (1-3)– Extent– Stage (1-5)– Presence or absence of plus disease


Zones and Extent


Extent

• Described by dividing the retinal surface into 12 segments (clock hours). The stage of retinopathy can vary among segments.


Stage I

- A fine, thin demarcation line between the vascular and avascular region is present-The demarcation line has no height and no thickness


Stage II

A broad, thick ridge clearly separates the vascular from the avascular retina


Stage III

Extraretinal fibrovascular proliferation (neovascularization):- Sites include the ridge, the posterior surface of the ridge, and anteriorly toward the vitreous cavity- The neovascularization gives the ridge a velvety appearance and a ragged border


Stage IV

- Subtotal retinal detachment beginning at the ridge- The retina is pulled anteriorly into the vitreous by the fibrovascular ridge (Stage 4A does not involve the fovea)( Stage 4B involves the fovea)


Stage V

This stage is a total retinal detachment in the shape of a funnel: (Stage 5A is an open funnel ) (Stage 5B is a closed funnel)


Plus disease

Presence indicates severe ROP and is often followed by rapid progression to retinal detachment. May be accompanied by vitreous haze, engorgement of the iris vessels, and poor dilation of the pupil.

defined as enlarged and twisting blood vessels in the back part of the eye.


Prevention

• Avoiding the risk factors and early interfering.


TreatmentSurgical Procedures Non-Surgical Procedures

• Cryotherapy• Laser photocoagulation• Scleral Buckle• Vitrectomy

• Oxygen• Light• Vitamins• DHEA• Other Supplements


Prognosis

• 90 % of stage 1-2 regress spontaneously

• 50% of stage 3+ also regress spontaneously

• The other 50% stage 3+, the incidence of severe visual impairment can be reduced by ~50% with treatment


Long Term Complications of ROP

Retinal Dragging and Folds

Others:Glaucoma , Late onset Retinal Detachment ,

Significant myopia , Anisometropia , Amblyopia

Strabismus


Any Question ?Any Question ?


Resources

Emedicine (medscape)

(Online Journal of Ophthalmology: www.onjoph.com)

med.stanford.edu


Thank you

retinopathy of prematurity

Health & Medicine

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