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Retinopathy of Prematurity
Retinopathy of
Prematurity (ROP), also known as retrolental fibroplasia, is a potentially blinding condition
affecting the retina of newborns. In the 1950's it was associated with
the use of high amounts of oxygen in neonatal units. Today, modern
neonatal care has curbed the incidence, yet because the survival rate of
low birth weight infants is much higher, the exposure of surviving
babies to required oxygen levels is increasing. The factors that put
infants at greatest risk of developing ROP are low birth weight (less
than 3.5 pounds) and premature delivery (26-28 weeks).
In babies
born prematurely, the growth and development of normal blood vessels in
the retina is halted and abnormal vessels may begin to develop. The
problem with abnormal vessel growth, known as neovascularization, is
that it does not deliver adequate oxygen supply to the retina. In
addition, it may cause many secondary problems.
ROP is classified in 5 stages, depending on the extent of the
disease. Progression of the disease to later stages can lead to the
formation of scar tissue in the retina and complications such as:
retinal detachment, vitreous hemorrhage, strabismus, and amblyopia. Many
children with ROP develop nearsightedness
SIGNS AND SYMPTOMS
Because newborns cannot communicate their symptoms, parents,
neonatologists, pediatricians and ophthalmologists are keenly aware of
risk factors for ROP.
•Low birth weight (3.5 pounds or less)
•The need for any oxygen within the first week after birth
•Unstable
health immediately after birth
Children with ROP as infants should be
watched for the following symptoms that could signal underlying problems
that may not surface until later:
•Holding objects very close
•Difficulty seeing distant objects
•Favoring or winking one eye
•Reluctance to use one eye
•Poor vision (previously undetected by the
physician)
•Sudden decrease of vision
•Crossed or turned eye
DETECTION AND DIAGNOSIS
Infants at risk for ROP should have an
ophthalmic examination at approximately 4-6 weeks of age. After
instilling a series of dilating drops in each eye, the doctor examines
the retina with an ophthalmoscope. The exam is often performed while a
parent holds the child.
Regardless of whether treatment is
required, children should be re-examined at recommended intervals to
determine if the progression of the disease has halted, or whether
treatment is required.
TREATMENT
Some children who develop
only stage 1-2 of the disease improve with no treatment. In other cases,
treatment is required if it reaches threshold. This is a term that
indicates the presence of stage 3 changes.
To prevent the
proliferation of abnormal vascularization, areas of the retina may be
frozen with a technique called cryotherapy. Alternatively, laser may be
used for the same purpose. Both treatments leave permanent scars in the
peripheral retina, but they are often successful in preserving central
vision.
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