Updated: 7/23/2019

Retinopathy of Prematurity

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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.
Introduction
  • Overview
    • 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
  • Prognosis
    • severe retinopathy of prematurity may lead to longterm visual loss or blindness
    • most mild retinopathy of prematuriy regress without treatment
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
Complication
  • Blindness
  • Retinal detachment

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