Retinopathy of prematurity: Recommendations for screening

Question 1

What is the classification/grading of ROP?

Answer 1

Stage 1: Demarcation line separates avascular from vascularized retina

Stage 2: Ridge arising in region of demarcation line

Stage 3: Extraretinal fibrovascular proliferation / neovascularization

Stage 4: Partial retinal detachment

Stage 5: Total retinal detachment

Plus Disease: Vascular dilatation and tortuosity of at least two quadrants of the eye

Question 2

Who do you screen for ROP and when?

Answer 2

Screen 27wks GA (f/u q2wks if no ROP, wkly if ROP, stop at 45wk PMA or if fully vascularized)
(The recommendations were developed to ensure that eyes that had a high probability of requiring treatment would be identified in a timely manner, while at the same time minimizing the number of examinations for infants at low risk)

Question 3

What is the pathophysiology of ROP?

Answer 3

ROP: vasoproliferative retinal disorder caused by a proliferation of abnormal vessels along the retina following a period of growth arrest.
(pre-phase: chorio, PIH = inflammatory states perinatally)
Phase 1 relative hyperoxia, decr VEGF
Phase 2 (~32wks) relative hypoxia, incr VEGF and neovascularization

Question 4

What is the treatment of ROP?

Answer 4

Retinal ablative therapy
Treatment is directed to the avascular part of the retina with the goal of decreasing the production of angiogenic growth factors
Laser photocoagulation or cryotherapy