Snapshot A neonate who received 40 days of supplemental oxygen is evaluated for retinopathy of prematurity (ROP). Examination of the infant's eyes shows a thickened, demarcated line and formation of an intraretinal ridge bilaterally. Summary A retinal vasculoproliferative disorder in premature infants an important cause of severe visual impairment in childhood Epidemiology Risk factors extremely low birth weight premature infants gestational age < 28 weeks Pathophysiology Normally, oxygen tension in the uterus is low, promoting normal vascular growth of the eyes Premature birth exposes the infant to a high oxygen tension environment before neuronal and vascular retinal development has completed this impairs blood vessel growth, leading to hypoxic injury to the retina Hypoxic injury to the retina increases vascular endothelial growth factor (VEGF) production, resulting in proliferation of new and leaky blood vessels that poorly perfuse the retina Presentation Physical exam ridge-like demarcation line between the vascularized and non-vascularized retina can have fibrovascular proliferation retinal detachment Differential Congenital cataract differentiating factor lens opacification Treatment Surgical laser photocoagulation indication first-line treatment intravitreal anti-VEGF injection indication first-line treatment Complications Blindness Retinal detachment Prognosis Severe retinopathy of prematurity may lead to longterm visual loss or blindness Most mild retinopathy of prematuriy regress without treatment