Retinopathy of Prematurity Flashcards
risk factors for ROP
Prenatal: prematurity, low birth weight
Postnatal: supplemental oxygen to newborns, slow rate of postnatal growth, sepsis, blood transufions
describe the zones of ROP
I: posterior retina within 60 degree circle centered around optic nerve
II: ring from zone I to nasal ora serrata
III: remaining retina
describe the stages of ROP
0: immature retinal vasculature without pathologic changes
1. demarcation line
2. demarcation ridge
3. demarcation ridge with extraretinal fibrovascular proliferation
4. partial RD (4a spares fovea, 4b includes fovea)
5. Total RD
What is plus disease in ROP?
Indicates significant presence of VEGF. Venous dilation and and arterial tortuosity in at least 2 quadrants. NVI also a sign of plus disease
What is aggressive posterior ROP (rush disease)?
vascularization ends in zone I or very posterior zone II and is accompanied by plus disease (may progress rapidly)
What is threshold disease for ROP?
Stage 3 RP in Zone I or II with either 5 continuous clock hours of extraretinal neovascularization, or 8 cumulative clock hours with plus disease. This signifies a 50% risk of progressing to Stage 4 (retinal detachment)
Describe the two types of prethreshold disease for ROP
Type I (higher risk):
- zone I with any plus
- zone I stage 3 without plus
- zone II stage 2-3 with plus
Type II (lower risk):
- zone I stage 1 or 2 without plus
- zone II stage 3 without plus
(zone II stage 1, and zone II stage 2 without plus do not meet criteria for prethreshold)
When does retinal vascularization generally start and finish?
starts week 16 of gestation. nasal retina finishes by week 36, temporal retina by 40
spontaneous regression of ROP occurs in ___% of eyes
85%
Initial screening recommendations for ROP
All infants born before 30 weeks or under 1500g
Describe the BEAT-ROP study and its findings
Compared bevacizumab to laser in any zone I disease and zone II stage 3 disease with plus. Bevacizumab was significantly better in zone I but equivocal in zone II. Recurrences occurred significantly later in bevacizumab compared to laser. Also, normal retinal vascular growth continued in bevacizumab while it was halted permanently in the laser group. Long term results not yet available, but this likely will soon drastically change ROP treatment algorithm.
Treatment for ROP?
All threshold and prethreshold type I. Laser is superior to cryo. anti-VEGF is likely superior to laser (see BEAT-ROP). If using laser, all avascular retina should be lasered. Treatment should be given within 72 hours of determining its need
Serious complication of laser treatment of ROP?
Respiratory or cardiac arrest in 5%
treatment for stage 4a ROP
lens-sparing vitrectomy is first line
Follow-up interval for ROP?
Complicated, but basically:
1 week or less for aggressive or threshold
1-2 weeks for prethreshold
2-3 weeks for zone III
