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Retinopathy of prematurity screening and treatment

Retinopathy of prematurity screening and treatment
Retinopathy of Prematurity (ROP) is a potentially serious eye condition that affects premature infants, particularly those born before 32 weeks of gestation or with low birth weight. It occurs when abnormal blood vessels grow in the retina, the light-sensitive layer at the back of the eye. Early screening and timely treatment are crucial to prevent vision loss or blindness caused by ROP.
This guide provides a comprehensive overview of ROP screening, its risk factors, and treatment options.

What is Retinopathy of Prematurity (ROP)?

Retinopathy of Prematurity is a disease of the retina that primarily affects infants born prematurely. It arises due to abnormal development of the retinal blood vessels, leading to uncontrolled growth.

Stages of Retinopathy of Prematurity

ROP progresses in stages, with each stage reflecting the severity of the condition:

  1. Stage 1: Mildly abnormal blood vessel growth. This stage may resolve on its own without treatment.
  2. Stage 2: Moderate abnormal blood vessel growth with more noticeable changes in the retina.
  3. Stage 3: Severe abnormal blood vessel growth with the possibility of scar tissue development.
  4. Stage 4: Partial retinal detachment, which can impair vision.
  5. Stage 5: Complete retinal detachment, the most severe stage of ROP, leading to significant vision loss or blindness.

Early detection and intervention can prevent ROP from advancing to the later stages.

When Should Screening Begin?

Screening guidelines depend on gestational age and birth weight:

  • Infants born at <28 weeks gestation or with a birth weight of <1,000 grams should begin screening by 4 weeks of life.
  • Infants born at 28 to 30 weeks gestation or with birth weights between 1,000 and 1,500 grams should begin screening by 4 to 6 weeks of life.
  • Infants with high-risk complications or abnormal oxygen exposure should be screened earlier or more frequently.

Treatment Options for Retinopathy of Prematurity

If ROP is detected, treatment depends on the severity and stage of the condition. Early treatment can halt or slow the progression of ROP and preserve vision.

1. Observation for Early-Stage ROP

In very mild cases (e.g., Stage 1 or Stage 2), treatment may not be necessary. Instead, careful monitoring with regular eye exams is performed to ensure the condition does not progress on its own.

2. Laser Therapy

Laser photocoagulation is one of the most common treatments for advanced ROP. The procedure works by targeting and destroying abnormal blood vessels in the retina to stop further growth.

How Laser Therapy Works:

  • A laser is used to create precise burns in areas of the retina where abnormal blood vessel growth has occurred.
  • This reduces the oxygen demand of the retina and halts the progression of ROP.

Laser therapy is usually performed in infants with Stage 3 or higher ROP and has a high success rate when performed early.

3. Anti-VEGF Injections

Anti-vascular endothelial growth factor (anti-VEGF) medications, such as bevacizumab (Avastin) or ranibizumab (Lucentis), are injected into the eye to block the growth of abnormal blood vessels. These medications are used for infants with advanced or aggressive forms of ROP.

Benefits of Anti-VEGF Therapy:

  • Slows or stops the abnormal growth of blood vessels.
  • Preserves vision by halting retinal detachment.

Anti-VEGF injections are often an alternative or complement to laser treatment, depending on the stage of ROP and the infant’s condition.

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