Retinopathy of prematurity: An update on screening and management Flashcards

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1
Q

What is ROP?

A

a proliferative disorder of the developing retinal blood vessels in preterm infants, may lead to poor visual acuity or blindness

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2
Q

What percentage of neonates born <31wks GA develop some stage of ROP?

A

40-50%

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3
Q

What percentage of neonates born <31wks GA develop severe ROP?

A

7-8%

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4
Q

What percentage of neonates born <31wks GA require ROP treatment?

A

5-6%

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5
Q

What are the stages of ROP?

A

Stage 1 - demarcation line separating avascular from vascularized retina

Stage 2 - Ridge arising in region of demarcation line

Stage 3 - Extraretinal fibrovascular proliferation/neovascularization extending into the vitreous

Stage 4 - Partial retinal detachment

Stage 5 - Total retinal detachment

Plus disease - Increased vascular dilatation and tortuosity of posterior retinal vessels in at least two quadrants of the retina

Pre-plus disease - More vascular dilatation and tortuosity than normal but insufficient to make the diagnosis of plus disease

Type 1 ROP:

a) Zone I – any stage ROP with plus disease as well as stage 3 ROP without plus disease
b) Zone II – stage 2 or 3 ROP with plus disease

Type 2 ROP

a) Zone I – stage 1 or 2 ROP without plus disease
b) Zone II – stage 3 ROP without plus disease
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6
Q

What are the current indications for treatment of ROP (Type 1 ROP)?

A
  1. Zone I – any stage ROP with plus disease
  2. Zone I – stage 3 ROP without plus disease
  3. Zone II – stage 2 or 3 ROP with plus disease
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7
Q

What is the recommendations regarding ROP screening in Canada?

A
  1. All infants <31 weeks GA
  2. Infants = 1250g
  3. Infants believed to be at high risk for ROP
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8
Q

When should the first ROP screening examination occur?

A

At 31 weeks GA for infants 22-27 weeks GA

At 4 weeks chronological age for infants born at >28 weeks GA

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9
Q

What type of screening can be used in the community?

A

Digital retinal photography

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10
Q

What methods should be used for analgesia in pain control?

A
  1. Pacifiers
  2. Topical anesthetics
  3. Swaddling
  4. Sucrose
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11
Q

What are indications for follow-up in >1 week?

A
  1. Immature vascularization, zone 1 - no ROP
  2. Immature retina extends into posterior zone II, near boundary of zone I
  3. Stage 1 or 2 ROP, no plus disease, zone I
  4. Stage 3 ROP, no plus disease, zone II
  5. Presence or suspected presence of aggressive posterior ROP
  6. Inability to determine zone due to hazy view
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12
Q

What are the indications for follow-up in 1-2 weeks?

A
  1. Immature vascularization, posterior zone II

2. Stage 2 ROP, no plus disease, zone II

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13
Q

What are the indications for follow-up in 2 weeks?

A
  1. Stage 1 ROP, no plus disease, zone II
  2. Immature vascularization, zone II – no ROP
  3. Unequivocally regressing ROP, zone II
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14
Q

What are indications for follow-up in 2-3 weeks?

A
  1. Stage 1 or 2 ROP, no plus disease, zone III

2. Regressing ROP, zone III

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15
Q

What are the indications to stop screening?

A
  1. Vascularization in zone III without previous zone I or II ROP
  2. Full retinal vascularization in close proximity to the ora serrata for 360°
  3. Postmenstrual age of 50 weeks and no prethreshold or worse ROP
  4. Regression of ROP (no abnormal vascular tissue capable of reactivation and progression present in zone II or III)
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16
Q

What are the options for treatment?

A
  1. Retinal ablation with laser photocoagulation within 72h of detection
  2. Antivascular endothelial growth factor (anti-VEGF) therapy recent and controversial