RETINOPATHY OF PREMATURITY · RETINOPATHY OF PREMATURITY Renopathy of Prematurity (ROP) is a...
Transcript of RETINOPATHY OF PREMATURITY · RETINOPATHY OF PREMATURITY Renopathy of Prematurity (ROP) is a...
NEWBORN CARE WEEK NOVEMBER 15-21
WORLD PREMATURITY DAY NOVEMBER 17
RETINOPATHYOFRETINOPATHYOFPREMATURITYPREMATURITY
RETINOPATHYOFPREMATURITY
PRETERMBABIESTOO,HAVETHERIGHTTOSIGHT
In the context of preven�ng
blindness in newborn babies,
Re�nopathyofPrematurity(ROP)
hasemergedasaseverechallenge
par�cularly in developing and
middle-incomegroupcountriesin
La�n America, Eastern Europe,
SouthEastAsia,ChinaandIndia.
ROP is a poten�ally avoidable
cause of irreversible and usually
totalblindnessinpretermbabies.
T h i s d i s e a s e h a s l i f e l o n g
implica�ons for afflicted children
andtheirfamilies.
India con�nues to lead with the
l a rge st n u m b e r o f v i s u a l l y
impaired and blind children,
globally.
Many countries like India are
expanding neonatal care but lack
sufficient knowledge, effec�ve
screening guidelines and bedside
programsforROP.
M o r e t h a n 6 0 % o f v i s u a l
i m p a i r m e nt s i n b a b i e s a re
preventableorcurablewith�mely
d e t e c � o n , p r o m p t a n d
appropr iate preven�ve and
cura�vemanagement.
The World Health Organiza�on
(WHO) has highlighted ROP as a
major target d i sease in i t s
preven�on of blindness program,
“VISION 2020: Right to Sight” to
combat need less b l indness
globallybytheyear2020.
Theprogramtargetsallbabiesat
risk for ROP, for screening eye
examina�ons and access to
treatmentforsevereROP.
02 03
PRETERMBABIESTOO,HAVETHERIGHTTOSIGHT
In the context of preven�ng
blindness in newborn babies,
Re�nopathyofPrematurity(ROP)
hasemergedasaseverechallenge
par�cularly in developing and
middle-incomegroupcountriesin
La�n America, Eastern Europe,
SouthEastAsia,ChinaandIndia.
ROP is a poten�ally avoidable
cause of irreversible and usually
totalblindnessinpretermbabies.
T h i s d i s e a s e h a s l i f e l o n g
implica�ons for afflicted children
andtheirfamilies.
India con�nues to lead with the
l a rge st n u m b e r o f v i s u a l l y
impaired and blind children,
globally.
Many countries like India are
expanding neonatal care but lack
sufficient knowledge, effec�ve
screening guidelines and bedside
programsforROP.
M o r e t h a n 6 0 % o f v i s u a l
i m p a i r m e nt s i n b a b i e s a re
preventableorcurablewith�mely
d e t e c � o n , p r o m p t a n d
appropr iate preven�ve and
cura�vemanagement.
The World Health Organiza�on
(WHO) has highlighted ROP as a
major target d i sease in i t s
preven�on of blindness program,
“VISION 2020: Right to Sight” to
combat need less b l indness
globallybytheyear2020.
Theprogramtargetsallbabiesat
risk for ROP, for screening eye
examina�ons and access to
treatmentforsevereROP.
02 03
RETINOPATHYOFPREMATURITY
Re�nopathyofPrematurity(ROP)
isadynamic,�me-bounddisease
thatisnotpresentatbirth.
The condi�on afflicts the eyes of
pretermbabiesthathavetypically
received hospital based neonatal
care (with or without oxygen
therapy) that helps to save their
life,butseverelyaffectstheireye
development.
Thecondi�on is characterizedby
development of abnormal blood
vessels in the re�na of the eye,
resul�ng in scarring and re�nal
detachment.
ROPcanbemildandmayresolve
spontaneously, but in serious
cases, may progress rapidly and
leadtoblindness.
ROPtypicallystartsonly2-3weeks
a�er birth, providing a window
periodforscreeningandini�a�ng
treatmentattheright�me,while
the baby is s�ll under neonatal
careatthehospital.
04 05
RETINOPATHYOFPREMATURITY
Re�nopathyofPrematurity(ROP)
isadynamic,�me-bounddisease
thatisnotpresentatbirth.
The condi�on afflicts the eyes of
pretermbabiesthathavetypically
received hospital based neonatal
care (with or without oxygen
therapy) that helps to save their
life,butseverelyaffectstheireye
development.
Thecondi�on is characterizedby
development of abnormal blood
vessels in the re�na of the eye,
resul�ng in scarring and re�nal
detachment.
ROPcanbemildandmayresolve
spontaneously, but in serious
cases, may progress rapidly and
leadtoblindness.
ROPtypicallystartsonly2-3weeks
a�er birth, providing a window
periodforscreeningandini�a�ng
treatmentattheright�me,while
the baby is s�ll under neonatal
careatthehospital.
04 05
40CRITICALWEEKS
Thelasttwelveweeksofanormal
term gesta�on are crucial in the
developmentoffetaleyes.
The fetal re�na (�ssue that lines
the back of the eye) slowly
maturesinthemother'swombby
40weeks,whichisbytheexpected
dateofdelivery.
From 16 weeks to birth, re�nal
blood vessels grow out from the
op�cnervetoreachtheperipheral
re�na.
In preterm babies, the normal
growthofbloodvesselsstops.The
area without adequate blood
supplyemitsachemicaltriggerto
s�mulate growth of abnormal
vessels.
Theseabnormalbloodvesselsare
fragileandcan leadto forma�on
of a ring of scar �ssue that is
a�ached to both the re�na and
thevitreousgelthatfillsthecenter
oftheeyes.
Asthescar�ssuecontracts,itmay
pull the re�na out of posi�on,
crea�ngare�naldetachment.
Re�nal detachment is the prime
cause of visual impairment and
blindnessinROP.
06 07
40CRITICALWEEKS
Thelasttwelveweeksofanormal
term gesta�on are crucial in the
developmentoffetaleyes.
The fetal re�na (�ssue that lines
the back of the eye) slowly
maturesinthemother'swombby
40weeks,whichisbytheexpected
dateofdelivery.
From 16 weeks to birth, re�nal
blood vessels grow out from the
op�cnervetoreachtheperipheral
re�na.
In preterm babies, the normal
growthofbloodvesselsstops.The
area without adequate blood
supplyemitsachemicaltriggerto
s�mulate growth of abnormal
vessels.
Theseabnormalbloodvesselsare
fragileandcan leadto forma�on
of a ring of scar �ssue that is
a�ached to both the re�na and
thevitreousgelthatfillsthecenter
oftheeyes.
Asthescar�ssuecontracts,itmay
pull the re�na out of posi�on,
crea�ngare�naldetachment.
Re�nal detachment is the prime
cause of visual impairment and
blindnessinROP.
06 07
*TEESDINROSHNIKE !
Chronic hypoxia (lack of oxygen),
intrauterine growth retarda�on
and prenatal and postnatal
condi�onsarethemostcommon
triggersofROP.
Babies born under 34 weeksgesta�on and weighing less than2000 grams are par�cularlysuscep�ble to ROP and must bescreened within 20-30 days frombirth.
High levels of supplementaloxygen and high carbon dioxidelevelsarealsoknowntoaggravateROP.Duringneonatal incuba�on,pretermbabiesaretobeprovided
with blended oxygen, strictlycontrolled and monitored usingpulseoxymeters.
Other r i sk factors that areassociated with the condi�onincludeanemia,bradycardia (lowheartrate),bloodtransfusionsandintraven�cular hemorrhage(bleedingintothebrain).
Addi�onally, prenatal maternalfactorscompoundtheprobabilityof an ROP occurrence. Theseinclude infer�lity treatments,twinsandtriplets,heavysmoking,a n e m i a , d i a b e t e s a n dpreeclampsia.
*Thirtydaystovision!
08 09
*TEESDINROSHNIKE !
Chronic hypoxia (lack of oxygen),
intrauterine growth retarda�on
and prenatal and postnatal
condi�onsarethemostcommon
triggersofROP.
Babies born under 34 weeksgesta�on and weighing less than2000 grams are par�cularlysuscep�ble to ROP and must bescreened within 20-30 days frombirth.
High levels of supplementaloxygen and high carbon dioxidelevelsarealsoknowntoaggravateROP.Duringneonatal incuba�on,pretermbabiesaretobeprovided
with blended oxygen, strictlycontrolled and monitored usingpulseoxymeters.
Other r i sk factors that areassociated with the condi�onincludeanemia,bradycardia (lowheartrate),bloodtransfusionsandintraven�cular hemorrhage(bleedingintothebrain).
Addi�onally, prenatal maternalfactorscompoundtheprobabilityof an ROP occurrence. Theseinclude infer�lity treatments,twinsandtriplets,heavysmoking,a n e m i a , d i a b e t e s a n dpreeclampsia.
*Thirtydaystovision!
08 09
Newborncareunit:NearlyeverypretermbabyherewouldbeathighriskforROP.
BORNTOOSOON
E a r l y s t a g e s o f R O P, w h e r etreatment is effec�ve, have nosymptomsandtheeyelooksnormalfromtheoutside.
Hence, rou�ne re�nal screeningwithin3-4weeksofbirthistheonlyway to detect vision-threateningstagesofROP.
Preterm babies born at 23-27weeks should be examinedwithinthreeweeksofbirth.
Preterm babies born at orbeyond 28 weeks should beexaminedbythefourthweek,byDay-30oflife.
P reterm babies should beexaminedpriortodischargefromthe hospital if they are likely tomissafollow-upexamina�on.
During this period, most pretermbabiesareincri�calcareando�enincubatedinNeonatalIntensiveCareUnits (NICU) and Special NewbornCareUnits(SNCU).
Aneyespecialistmustbeappointedat the neonatal care hospital, toexamine the re�na of newborns.Caregiversneedtobegeareduptoc o n d u c t R O P s c re e n i n g a n dt r e a t m e n t i n s u c h a d v e r s esitua�ons.
For posi�ve outcomes, treatmentwithlaserphotocoagula�onmustbecarried out within 72 hours of
detec�onofthecondi�on.
F o l l o w - u p s c r e e n i n g a sr e c o m m e n d e d a � e r i n i � a lexamina�on must be st r ic t lyfollowedtoavoidirreversiblevisionloss.
Allpretermchildrenrunahigherriskindevelopingothereyeandvision-related complica�ons later in theirlives.
EvenpretermchildrenwithoutROPcondi�on are likely to developsquint, lazy eyes (amblyopia) andsignificant refrac�ve problems thatrequireprescrip�oneyeglasses.
Thus, bi-annual eye examina�onsare recommended for all pretermbabies born under 34 weeks orweighinglessthan2000grams.
The most effec�ve preven�on ofROPisthepreven�onofprematurebirththatiscurrentlynotpossible.Infactthese instancesareontherisepar�allyduetoassistedfer�liza�ontechniques that o�en result inprematureandmul�plebirths.
Preven�ng other complica�ons ofprematurity (such as neonatalrespiratory distress syndrome) mayalso help prevent ROP. Antenatalsteroids administered to high-riskmothers are one of the op�onsavailable.
10 11
Newborncareunit:NearlyeverypretermbabyherewouldbeathighriskforROP.
BORNTOOSOON
E a r l y s t a g e s o f R O P, w h e r etreatment is effec�ve, have nosymptomsandtheeyelooksnormalfromtheoutside.
Hence, rou�ne re�nal screeningwithin3-4weeksofbirthistheonlyway to detect vision-threateningstagesofROP.
Preterm babies born at 23-27weeks should be examinedwithinthreeweeksofbirth.
Preterm babies born at orbeyond 28 weeks should beexaminedbythefourthweek,byDay-30oflife.
P reterm babies should beexaminedpriortodischargefromthe hospital if they are likely tomissafollow-upexamina�on.
During this period, most pretermbabiesareincri�calcareando�enincubatedinNeonatalIntensiveCareUnits (NICU) and Special NewbornCareUnits(SNCU).
Aneyespecialistmustbeappointedat the neonatal care hospital, toexamine the re�na of newborns.Caregiversneedtobegeareduptoc o n d u c t R O P s c re e n i n g a n dt r e a t m e n t i n s u c h a d v e r s esitua�ons.
For posi�ve outcomes, treatmentwithlaserphotocoagula�onmustbecarried out within 72 hours of
detec�onofthecondi�on.
F o l l o w - u p s c r e e n i n g a sr e c o m m e n d e d a � e r i n i � a lexamina�on must be st r ic t lyfollowedtoavoidirreversiblevisionloss.
Allpretermchildrenrunahigherriskindevelopingothereyeandvision-related complica�ons later in theirlives.
EvenpretermchildrenwithoutROPcondi�on are likely to developsquint, lazy eyes (amblyopia) andsignificant refrac�ve problems thatrequireprescrip�oneyeglasses.
Thus, bi-annual eye examina�onsare recommended for all pretermbabies born under 34 weeks orweighinglessthan2000grams.
The most effec�ve preven�on ofROPisthepreven�onofprematurebirththatiscurrentlynotpossible.Infactthese instancesareontherisepar�allyduetoassistedfer�liza�ontechniques that o�en result inprematureandmul�plebirths.
Preven�ng other complica�ons ofprematurity (such as neonatalrespiratory distress syndrome) mayalso help prevent ROP. Antenatalsteroids administered to high-riskmothers are one of the op�onsavailable.
10 11
NATIONAL ROP TASK FORCE (2014 - TILL DATE)
Chair: 1) Smt Vandana Gurnani, Joint Secretary (RMNCH+A), Ministry of Health and Family Welfare
2) Dr R Azad , Ophthalmology expert, Ex Director, Dr R.P. Centre forOphthalmic Sciences, All India Institute for Medical Sciences (AIIMS), New Delhi
Members:� Prof Ashok Deorari, Professor, Paediatrics, AIIMS, New Delhi � Dr Ramesh Agarwal, Neonatologist, AIIMS, New Delhi � Dr Praveen Vashist, Additional Professor and Head, Community
� Dr N K Agarwal, Deputy Director General (O), National Programme
� Dr Gagan Gupta, Country Director, United Nations International
� Dr Shikar Jain, President, National Neonatology Forum of India � Dr Hema Diwakar, Representative, Federation of Obsterics and
Gynaecological Societies of India
� Dr Manju Vatsa, President, India Association of Newborn Nursing � Dr GVS Murthy, Principal Investigator, Director-Public Health Foundation
of India, Hyderabad
� Dr Rajan Shukla, Co-investigator, Public Health Foundation of India,Hyderabad
� Dr Sara Varughese, President, VISION 2020 India� Prof Clare Gilbert, Principal Investigator, London School of Hygiene and
Tropical Medicine (Advisor to The Queen Elizabeth Diamond Jubilee Trust)
� Dr P K Prabhakar, Deputy Commissioner (Child Health), Ministry of Health and Family Welfare
� Dr Arun Singh, National Advisor (RBSK), Ministry of Health and FamilyWelfare
� Dr Renu Srivastava, SNCU Coordinator, Ministry of Health & Family Welfare
Ministry of Health and Family Welfare
12
Opthalmology, Dr. R.P.Centre for Ophthalmic Sciences, AIIMS
for Control of Blindness (NPCB)
Children’s Fund
NATIONALROPTASKFORCE(2014-TILLDATE)
Chair:DrRakeshKumar,JointSecretary(RMNCH+A),MinistryofHealth
andFamilyWelfareCo-chair: Professor Y R Sharma, AIIMS Ophthalmologist, Co-Program
Director,AIIMS,NewDelhi
Members: ProfAshokDeorari,AIIMSNeonatologist,Co-ProgramDirector DrRameshAgarwal,AIIMSNeonatologist DrPraveenVashist,AIIMS,CommunityOpthalmology ProfRVAzad,AIIMS,PrincipalAdvisor,Opthalmology DrNKAgarwal,NPCB,DeputyDirectorGeneral(o),DGHS DrGaganGupta,UNICEFCountryDirector DrShikarJain,NNFPresidentorRepresenta�ve DrHemaDiwakar,FOGSIPresidentorRepresenta�ve DrManjuVatsa,IndiaAssocia�onOfNewbornNursing,President DrGVSMurthy,PHFIrepresenta�ve,ProgrammeManager DrRajanShukla,PHFIrepresenta�ve,TechnicalAdvisor DrSaraVarughese,VISION2020India,President Prof Clare Gilbert, The Queen Elizabeth Diamond Jubilee Trust,
Representa�ve DrPKPrabhakar,DeputyCommissioner (ChildHealth),Ministryof
Health&FamilyWelfare DrArunSingh,Na�onalAdvisor(RBSK),MinistryofHealth&Family
Welfare DrRenuSrivastava, SNCUCoordinator,MinistryofHealth&Family
Welfare
MinistryofHealthandFamilyWelfare ExpertWorkingGroup
(a)NeonatologyFaculty
DrPraveenKumar,PGIMER,Chandigarh DrDeepakChawla,GMCH,Chandigarh DrSrinivasMurki,FernandezHospital,Hyderabad DrVenkatSeshan,PGIMER,Chandigarh
(b)ROPProgramFaculty
DrParijatChandra,AIIMS,NewDelhi DrSubhadraJalali,LVPEI,Hyderabad DrMangatDogra,PGIMER,Chandigarh DrVNarendran,AravindEyeHospital,Coimbatore DrPramodBhende,SankaraNethralaya,Chennai DrAnandVinekar,NarayanaNethralaya,Bangalore
Convener:DrAjayKhera,DeputyCommissioner-in-charge(ChildHealth
andImmuniza�on),MinistryofHealth&FamilyWelfare
12 13
NATIONALANNUALROPSCENARIOINRECENTYEARS
HOSPITALSININDIAGEARINGUPTOHANDLECOMPLICATEDROPCASES
Note: DatacollectedfromindividualeyehospitalsacrossIndia SurgeriesperformedincludeLaser,VitrectomiesandAn�VEGFinjec�ons
Ateamofophthalmologistsveryrecentlywerechallengedtoperformadifficultsurgerya�nybaby,just6weeksoldandnotgainingweight,sufferingfrom a cri�cal, poten�ally blinding condi�on - Re�nopathy of Prematurity(ROP).Itcouldhavepermanentlydestroyedthere�naofboththeeyesifnotoperatedwithin3days!
Whentheparentsofthatfragilebabycametothehospitalforthefirst�me,theyweredoub�ulwhetheranIndianhospitalwillbeequippedtohandlesuchadelicateandchallengingcase.Theparentsweretoldthatanemergencyopera�onwasrequired;risksandbenefitswereclearlylaidout.The low weight of the baby was a challenge for the team ofophthalmologists, anesthe�sts, nursing staff, counsellors, and theneonatologistduetoaveryhighriskofanesthesia-relatedcomplica�ons,eveninthebestofcentres.Theparentsfinallyconsentedtothesurgery,reassuredbythegenuineconcernofthedoctorsfortheirchild’svisionandlife.
Anemergencycoreteamwascons�tuted.Notonlypremature,thebabywasanaemicandsufferingfrompoornutri�on.Counsellorscoordinatedwith the baby’s neonatologist and the parents for all the preopera�veevalua�onandpaperwork,without�ringthis�nylife.
Allprepara�onsweremadewithin48hourstomakethebabyasfitaspossibleforsafeanesthesia.Bloodtransfusion,lungs,liverfunc�on,kidneyfunc�on,nutri�onandelectrolytebalance,cardiaccare–somuchtobeassessedandmanagedatsuchshortno�ce!Thebabywasbroughttothetheatre and a highly competent neonatal anesthesiologist, played thepivotalrole,supportedbyseniorcolleagueandtheanesthesiatechnician.
Anaccomplishedre�nalsurgeon,operateduponboththebaby'seyesusingmicrosurgicaltechniques.Opera�nguponaneyelessthan16mminsize,without causingdamage tocri�cal structures like the lensand there�na,requiredsurgicalprecision,dexterityandapassionforperfec�on.Whenthebabys�rredoutofanesthesiaandcried,thewholeteamandtheanxiousadministrators,counsellorsandparentsoutside,knewthattheyhadallcollec�velyasateamsucceededinsavingtheeyesightofthebaby.Lessthanamonthlater,thehealthyandhappybabyspreadsunshineonareturnvisit,asshesmiledatthedoctor,lookingupwithpre�ygoodvisioninbothherbrighteyes!
HospitalsinIndiaarenowsuccessfullyhandlingROPcasesandarealsotrea�ngpa�entsfromneighboringcountries.
16 17
NATIONALANNUALROPSCENARIOINRECENTYEARS
HOSPITALSININDIAGEARINGUPTOHANDLECOMPLICATEDROPCASES
Note: DatacollectedfromindividualeyehospitalsacrossIndia SurgeriesperformedincludeLaser,VitrectomiesandAn�VEGFinjec�ons
Ateamofophthalmologistsveryrecentlywerechallengedtoperformadifficultsurgerya�nybaby,just6weeksoldandnotgainingweight,sufferingfrom a cri�cal, poten�ally blinding condi�on - Re�nopathy of Prematurity(ROP).Itcouldhavepermanentlydestroyedthere�naofboththeeyesifnotoperatedwithin3days!
Whentheparentsofthatfragilebabycametothehospitalforthefirst�me,theyweredoub�ulwhetheranIndianhospitalwillbeequippedtohandlesuchadelicateandchallengingcase.Theparentsweretoldthatanemergencyopera�onwasrequired;risksandbenefitswereclearlylaidout.The low weight of the baby was a challenge for the team ofophthalmologists, anesthe�sts, nursing staff, counsellors, and theneonatologistduetoaveryhighriskofanesthesia-relatedcomplica�ons,eveninthebestofcentres.Theparentsfinallyconsentedtothesurgery,reassuredbythegenuineconcernofthedoctorsfortheirchild’svisionandlife.
Anemergencycoreteamwascons�tuted.Notonlypremature,thebabywasanaemicandsufferingfrompoornutri�on.Counsellorscoordinatedwith the baby’s neonatologist and the parents for all the preopera�veevalua�onandpaperwork,without�ringthis�nylife.
Allprepara�onsweremadewithin48hourstomakethebabyasfitaspossibleforsafeanesthesia.Bloodtransfusion,lungs,liverfunc�on,kidneyfunc�on,nutri�onandelectrolytebalance,cardiaccare–somuchtobeassessedandmanagedatsuchshortno�ce!Thebabywasbroughttothetheatre and a highly competent neonatal anesthesiologist, played thepivotalrole,supportedbyseniorcolleagueandtheanesthesiatechnician.
Anaccomplishedre�nalsurgeon,operateduponboththebaby'seyesusingmicrosurgicaltechniques.Opera�nguponaneyelessthan16mminsize,without causingdamage tocri�cal structures like the lensand there�na,requiredsurgicalprecision,dexterityandapassionforperfec�on.Whenthebabys�rredoutofanesthesiaandcried,thewholeteamandtheanxiousadministrators,counsellorsandparentsoutside,knewthattheyhadallcollec�velyasateamsucceededinsavingtheeyesightofthebaby.Lessthanamonthlater,thehealthyandhappybabyspreadsunshineonareturnvisit,asshesmiledatthedoctor,lookingupwithpre�ygoodvisioninbothherbrighteyes!
HospitalsinIndiaarenowsuccessfullyhandlingROPcasesandarealsotrea�ngpa�entsfromneighboringcountries.
16 17
18 19
FIVESTAGES
ROPmanifestsitselfinfivestages
that require varied courses of
managementandtreatment.
Stage-IThere is mild abnormal blood
vesselgrowththat requiresclose
periodicexamina�on,butmaynot
needanytreatment.
Stage-IIBloodvesselgrowthismoderately
abnormalandinsomecasesmay
needearlytreatment.
Stage-I and most Stage-II do not
leadtoblindness.Howeverifnot
monitored, they can progress to
moreseverestages.
Stage-IIIBlood vessel growth is severely
abnormal and the newborn
requiresearlytreatmentwithin72
hoursasthisisvisionthreatening.
Stage-IVBlood vessel growth is severely
abnormal and there is a par�ally
detached re�na. Urgent surgical
treatment is recommended to
diminish the chances of loss of
vision.
Stage-VThereisatotalre�naldetachment
andonlyveryfeweyesgetminimal
v is ion even a�er advanced
surgicaltreatment.
18 19
FIVESTAGES
ROPmanifestsitselfinfivestages
that require varied courses of
managementandtreatment.
Stage-IThere is mild abnormal blood
vesselgrowththat requiresclose
periodicexamina�on,butmaynot
needanytreatment.
Stage-IIBloodvesselgrowthismoderately
abnormalandinsomecasesmay
needearlytreatment.
Stage-I and most Stage-II do not
leadtoblindness.Howeverifnot
monitored, they can progress to
moreseverestages.
Stage-IIIBlood vessel growth is severely
abnormal and the newborn
requiresearlytreatmentwithin72
hoursasthisisvisionthreatening.
Stage-IVBlood vessel growth is severely
abnormal and there is a par�ally
detached re�na. Urgent surgical
treatment is recommended to
diminish the chances of loss of
vision.
Stage-VThereisatotalre�naldetachment
andonlyveryfeweyesgetminimal
v is ion even a�er advanced
surgicaltreatment.
1)Bornat28weeks1)Bornat28weeks1)Bornat28weeks
4)Re�nahasdetachedasscreeningwasnotdone4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgivenwithin30days&nolasertreatmentwasgiven4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgiven
3)Onscreening,treatableROPisdetected3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelaserin15-20%babies.Immediatelasertreatmentcancurethisbleedingtreatmentcancurethisbleeding
3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelasertreatmentcancurethisbleeding
2)Screeningdonewithin30daysofbirthto2)Screeningdonewithin30daysofbirthtoprotectvisionprotectvision2)Screeningdonewithin30daysofbirthtoprotectvision
6)LostvisionduetonoROPScreening6)LostvisionduetonoROPScreeningandverylatedetec�onandverylatedetec�on6)LostvisionduetonoROPScreeningandverylatedetec�on
5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision
20 21
ROPdevelops2-3weeksa�erbirthduetoprematurityandlowweight;and then worsens due to manyfactors.
If detected by a comprehensivere�nal examina�on within 20-30days from birth, ROP can becontrolledandmanagedthroughavarietyoftreatments.
LaserTherapyorPhotocoagula�onis themost common typeof ROPsurgeryinwhichsmalllaserbeamsare used to treat the peripheralre�naandstoptheprogression.
Cryotherapy deploys freezingtemperaturestoscartheperipheralre�na.
LaserTherapyandCryotherapyareonly performed on babies withadvancedROP,par�cularlyStage-IIwith 'plus disease' and Stage-IIIdisease.
Research studies are currentlybeing conducted for newer andevolved treatments using an�-VEGF injec�ons in the eye, as asupplement or subs�tute to lasertherapy.
For advanced stages of ROP,
treatment op�ons include ScleralBuckleandVitrectomy.
S c l e ra l B u c k l e s a re u s u a l l yperformedonbabiesinROPStage-IV.
Thisinvolvesplacingasiliconebandaround the eye and �ghtening it.This keeps the vitreous gel frompullingonthescar�ssueandallowsthe re�na to fla�en back downontothewalloftheeye.
Babies who have had a ScleralBuckle need to have the bandreleased months or even yearslater, since the eye con�nues togrow;otherwisetheywillbecomenearsighted.
Vitrectomy is performed foradvancedROPatStages-IVandV.
Thisinvolvesremovingthevitreousand replacing it with a salinesolu�on.
A�er the v i treous has beenremoved, the scar �ssue on there�na can be peeled back or cutaway, allowing the re�na to relaxandlaybackdownagainsttheeyewall.
BACKFROMTHEBRINK
1)Bornat28weeks1)Bornat28weeks1)Bornat28weeks
4)Re�nahasdetachedasscreeningwasnotdone4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgivenwithin30days&nolasertreatmentwasgiven4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgiven
3)Onscreening,treatableROPisdetected3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelaserin15-20%babies.Immediatelasertreatmentcancurethisbleedingtreatmentcancurethisbleeding
3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelasertreatmentcancurethisbleeding
2)Screeningdonewithin30daysofbirthto2)Screeningdonewithin30daysofbirthtoprotectvisionprotectvision2)Screeningdonewithin30daysofbirthtoprotectvision
6)LostvisionduetonoROPScreening6)LostvisionduetonoROPScreeningandverylatedetec�onandverylatedetec�on6)LostvisionduetonoROPScreeningandverylatedetec�on
5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision
20 21
ROPdevelops2-3weeksa�erbirthduetoprematurityandlowweight;and then worsens due to manyfactors.
If detected by a comprehensivere�nal examina�on within 20-30days from birth, ROP can becontrolledandmanagedthroughavarietyoftreatments.
LaserTherapyorPhotocoagula�onis themost common typeof ROPsurgeryinwhichsmalllaserbeamsare used to treat the peripheralre�naandstoptheprogression.
Cryotherapy deploys freezingtemperaturestoscartheperipheralre�na.
LaserTherapyandCryotherapyareonly performed on babies withadvancedROP,par�cularlyStage-IIwith 'plus disease' and Stage-IIIdisease.
Research studies are currentlybeing conducted for newer andevolved treatments using an�-VEGF injec�ons in the eye, as asupplement or subs�tute to lasertherapy.
For advanced stages of ROP,
treatment op�ons include ScleralBuckleandVitrectomy.
S c l e ra l B u c k l e s a re u s u a l l yperformedonbabiesinROPStage-IV.
Thisinvolvesplacingasiliconebandaround the eye and �ghtening it.This keeps the vitreous gel frompullingonthescar�ssueandallowsthe re�na to fla�en back downontothewalloftheeye.
Babies who have had a ScleralBuckle need to have the bandreleased months or even yearslater, since the eye con�nues togrow;otherwisetheywillbecomenearsighted.
Vitrectomy is performed foradvancedROPatStages-IVandV.
Thisinvolvesremovingthevitreousand replacing it with a salinesolu�on.
A�er the v i treous has beenremoved, the scar �ssue on there�na can be peeled back or cutaway, allowing the re�na to relaxandlaybackdownagainsttheeyewall.
BACKFROMTHEBRINK
22 23
FUTURECONCERNS
All preterm children run a higher risk in theAll preterm children run a higher risk in the
development of eye and vision-relateddevelopment of eye and vision-related
complica�onsotherthanROPlaterintheirlives.complica�onsotherthanROPlaterintheirlives.
Commonafflic�onsincludere�naldetachment,Commonafflic�onsincludere�naldetachment,
myopia(near-sightedness),strabismus(crossedmyopia(near-sightedness),strabismus(crossed
eyes),amblyopia(lazyeye)andglaucoma.eyes),amblyopia(lazyeye)andglaucoma.
Inmostcases,thesecondi�onscanbetreatedorInmostcases,thesecondi�onscanbetreatedor
controlled.controlled.
Bi-annual eye examina�ons are recommendedBi-annual eye examina�ons are recommended
forallpretermbabiesbornunder34weeksorforforallpretermbabiesbornunder34weeksorfor
thosethatweighlessthan2000grams.thosethatweighlessthan2000grams.
All preterm children run a higher risk in the
development of eye and vision-related
complica�onsotherthanROPlaterintheirlives.
Commonafflic�onsincludere�naldetachment,
myopia(near-sightedness),strabismus(crossed
eyes),amblyopia(lazyeye)andglaucoma.
Inmostcases,thesecondi�onscanbetreatedor
controlled.
Bi-annual eye examina�ons are recommended
forallpretermbabiesbornunder34weeksorfor
thosethatweighlessthan2000grams.
22 23
FUTURECONCERNS
All preterm children run a higher risk in theAll preterm children run a higher risk in the
development of eye and vision-relateddevelopment of eye and vision-related
complica�onsotherthanROPlaterintheirlives.complica�onsotherthanROPlaterintheirlives.
Commonafflic�onsincludere�naldetachment,Commonafflic�onsincludere�naldetachment,
myopia(near-sightedness),strabismus(crossedmyopia(near-sightedness),strabismus(crossed
eyes),amblyopia(lazyeye)andglaucoma.eyes),amblyopia(lazyeye)andglaucoma.
Inmostcases,thesecondi�onscanbetreatedorInmostcases,thesecondi�onscanbetreatedor
controlled.controlled.
Bi-annual eye examina�ons are recommendedBi-annual eye examina�ons are recommended
forallpretermbabiesbornunder34weeksorforforallpretermbabiesbornunder34weeksorfor
thosethatweighlessthan2000grams.thosethatweighlessthan2000grams.
All preterm children run a higher risk in the
development of eye and vision-related
complica�onsotherthanROPlaterintheirlives.
Commonafflic�onsincludere�naldetachment,
myopia(near-sightedness),strabismus(crossed
eyes),amblyopia(lazyeye)andglaucoma.
Inmostcases,thesecondi�onscanbetreatedor
controlled.
Bi-annual eye examina�ons are recommended
forallpretermbabiesbornunder34weeksorfor
thosethatweighlessthan2000grams.
ROPisanincreasingconcernamongstyoungparents.
Although medical innova�ons in ROP treatment have
decreasedtheprobabilityoflossofvision,unfortunatelyit
doesnotalwayspreventit.
If an infant does not respond to ROP treatment, the
diseasemayprogress,whereinare�naldetachmentcould
develop.
O�en,thisisa'Stage-IV'manifesta�oninwhichonlyapart
ofthere�nadetachesandmayneedurgentsurgery.
InaStage-Vpa�ent,thecentreofthere�naortheen�re
re�nadetaches.Centralvisionisthreatenedandsurgeryis
o�en recommended to rea�ach the re�na. However,
results are o�en not favorable, with most children
remainingpermanentlyblind.
BATTLINGAGAINSTTHEODDS
ROPisanincreasingconcernamongstyoungparents.
Although medical innova�ons in ROP treatment have
decreasedtheprobabilityoflossofvision,unfortunatelyit
doesnotalwayspreventit.
If an infant does not respond to ROP treatment, the
diseasemayprogress,whereinare�naldetachmentcould
develop.
O�en,thisisa'Stage-IV'manifesta�oninwhichonlyapart
ofthere�nadetachesandmayneedurgentsurgery.
InaStage-Vpa�ent,thecentreofthere�naortheen�re
re�nadetaches.Centralvisionisthreatenedandsurgeryis
o�en recommended to rea�ach the re�na. However,
results are o�en not favorable, with most children
remainingpermanentlyblind.
BATTLINGAGAINSTTHEODDS
26 27
EXAMINATIONOFREDREFLEXINNEWBORNS
1Examina�on of red reflex soon
a�er birth and per iodical ly
therea�er in EVERY NEWBORN
babyisacri�calmilestoneinthe
early detec�on of many serious
eyeproblems.Thisredreflextest
howevercannotdetectearlyROP.
Only a qualified and trained eye
specialist should perform ROP
screeningre�nalexamina�on.
Following pupillary dila�on using
eye drops, the baby's re�na is
examined in a dimly lit or dark
room, using a special lighted
instrument called an indirect
ophthalmoscope.
Examina�on of the re�na of a
pretermbabywilldeterminehow
farthere�nalbloodvesselshave
grown and whether or not the
vesselsaregrowingflatalongthe
walloftheeye.
1Theredreflexreferstothereddish-orangereflec�onoflightfromthere�naoftheeyethatis
observedwhenusinganophthalmoscopeorre�noscopefromapproximately30cmdistance.This
canalsobedetectedbyflashphotographyinadarkroomusingthecellphonecameraoraregular
digitalcamera.
26 27
EXAMINATIONOFREDREFLEXINNEWBORNS
1Examina�on of red reflex soon
a�er birth and per iodical ly
therea�er in EVERY NEWBORN
babyisacri�calmilestoneinthe
early detec�on of many serious
eyeproblems.Thisredreflextest
howevercannotdetectearlyROP.
Only a qualified and trained eye
specialist should perform ROP
screeningre�nalexamina�on.
Following pupillary dila�on using
eye drops, the baby's re�na is
examined in a dimly lit or dark
room, using a special lighted
instrument called an indirect
ophthalmoscope.
Examina�on of the re�na of a
pretermbabywilldeterminehow
farthere�nalbloodvesselshave
grown and whether or not the
vesselsaregrowingflatalongthe
walloftheeye.
1Theredreflexreferstothereddish-orangereflec�onoflightfromthere�naoftheeyethatis
observedwhenusinganophthalmoscopeorre�noscopefromapproximately30cmdistance.This
canalsobedetectedbyflashphotographyinadarkroomusingthecellphonecameraoraregular
digitalcamera.
NEWBORN CARE WEEK NOVEMBER 15-21
WORLD PREMATURITY DAY NOVEMBER 17
Pro
du
ced
by
LV
Pra
sad
Eye
Ins�
tute
,Oct
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016