Retinopathy of Prematurity

Sasha Mansukhani
Complications And Sequelae
1. Refractive errors- Myopia is a common sequel of regressed ROP in treated and untreated eyes. In one study around70%of high-risk prethreshold ROP eyes were myopic in early childhood, and the proportion with high myopia increased steadily between ages 6 months and 3 years(38). Therefore, the child should be closely monitored and the refractive error should be corrected to prevent amblyopia.
2. Strabismus(39)
3. Cataract(11)
4. Amblyopia(39)
5. Anterior segment abnormalities- ectropion uveae, iris neovascularization, rigid pupil(11)

Various risk factors have been found to cause Retinopathy of Prematurity (ROP), of which the most important after gestational age and birth weight is the arterial oxygen saturation.
Unrestricted and unmonitored oxygen delivery to the preterm, which has been proven by meta-analysis to increase the incidence as well as the severity of ROP, should be avoided(40). However, lower target ranges have been found to be associated with increased mortality and an ideal range of arterial oxygen saturation, which prevents ROP without affecting mortality, is still to be established(41).

Referral of a preterm baby for ophthalmic examination as per the guidelines of screening is a must and failure to do so can result in blindness.

Screening is to be done for(24):-
1. All Preterms babies born at <34 wks gestational age
2. All preterm babies with birth weight <1750 Kgs
3. All preterm babies born at 34-36 wks gestational age or 1750-2000 Kgs at birth if:-
•Stormy neonatal course
•Prolonged oxygen delivered
•Oxygen fluctuations
•Any major surgery
•Severe anemia
4. All babies whose gestational age is not known.
First screening of the neonate is to be done at 4 weeks after delivery, earlier (2-3 weeks) if the child is born at <28 weeks or is <1200g(24).
Preterm babies who are large for gestational age, such as those born to diabetic mothers, & babies with hydrocephalus, intestinal obstruction and renal disease etc. can also develop severe ROP. Similarly, preterm babies born after assisted fertilization techniques, irrespective of birth weight can develop ROP. Babies who have not been given oxygen can also develop ROP.
ROP is a potentially blinding disease, and is an important cause of blindness as the neonate at risk has a lifetime ahead of him. Furthermore, the risk of blindness can be substantially reduced by timely diagnosis and treatment. Thus team work involving the neonatologist, ophthalmologist, nursing staff and parents is necessary in bringing the epidemic of ROP under control.
The LV Prasad Eye institute in Hyderabad has developed an efficient NICU based screening model of ROP, with a Day 30 strategy in which all neonates at risk are screened directly in the NICU by 30th day of age(42) and babies screened under this protocol had the better outcomes(43).
Every neonatal intensive care unit and neonatologist should have organized the logistics of a good screening protocol so that no baby goes unscreened.

The photographs have been provided by Dr Subhadra Jalali, Associate Director, Consultant – Srimati Kannuri Santhamma centre for vitreoretinal diseases and Jasti V Ramanamma Children’s Eye Care Centre, L.V.Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad. She has received the Sight Savers grant (2003-2005) for setting up treatment and training centres for the control of childhood blindness in the field of ROP and is on the Ministry of Health National task force on ROP. Her work in ROP has made a tremendous difference in preventing blindness in the twin cities of Hyderabad and Secunderabad as well as establishing a screening protocol that is worthy of emulation all over India and other developing countries.

Retinopathy of Prematurity Retinopathy of Prematurity 11/05/2014
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