Retinopathy of Prematurity

Question 1

What is Retinopathy of Prematurity?

Answer 1

• This is abnormal development of the blood vessels in the retina which can lead to scarring, retinal detachment and blindness
• Typically affects preterm/ low birth weight babies (before 32 weeks)

Question 2

When does retinal blood vessel development start?

Answer 2

• Starts at 16 weeks and is completed by 37/40 weeks gestation

Question 3

What is the Pathophysiology of Retinopathy of Prematurity?

Answer 3

• When the retina is exposed to higher oxygen concentrations in a preterm baby, particularly with supplementary oxygen, the stimulant for normal blood vessel development is removed.
• When the hypoxic environment recurs, the retina responds by producing excessive blood vessels (neovascularisation) as well as scar tissue.
• These abnormal blood vessels may regress and leave the retina without a blood supply.
• The scar tissue causes retinal detachment

Question 4

What is the normal pathophysiology of the Retina?

Answer 4

• The Retinal vessel formation is stimulated by hypoxia
• This is a normal condition when in pregnancy

Question 5

What zones are the retina divided into?

Answer 5

• Zone 1 includes the optic nerve and macula
• Zone 2 is the edge of zone 1 to the ora serrata (pigmented border between the retina and the ciliary body)
• Zone 3 is outside the ora serrata

Question 6

What Screening is there for Retinopathy of Prematurity?

Answer 6

• Babies before 32 weeks need to be screened for ROP
• Screening starts at:
  -30-31 weeks gestational age in babies born before 27 weeks
• 4-5 weeks of age in babies born after 27 weeks

Question 7

How often should screening occur?

Answer 7

• Screening should occur at least every 2 weeks

Question 8

When should screening cease?

Answer 8

• Screening should cease once the retinal vessels enter zone 3

Question 9

What should be done on examination?

Answer 9

• All retinal areas need to be visualised.
• Screening involves looking at the retinal vessels and looking for plus disease

Question 10

What is the treatment for Retinopathy of Prematurity?

Answer 10

• Systematically targeting areas of the retina to stop new blood vessels developing
• 1st Line: Transpupillary laser photocoagulation (halts and reverses neovascularisation)
• Other: Cryotherapy and Injections of Intravitreal VEGF inhibitors
• Surgery: if retinal detachment occurs