ROP

Question 1

Vascularization of the Retina

Answer 1

Fetus is Hypoxic ar 25-35 mm/Hg

Question 2

VEGF: Vascular Endothelial Growth Factor

Answer 2

You will not grow blood vessesl unless you have this

Question 3

IGF-1: Insulin-like growth factor 1

Answer 3

need IGF-1 for VEGF to work; it gives it “permission”

Question 4

IN THE FETUS: VEGF production is regulated by oxygen

Answer 4

VEGF increases by hypoxia and decreases with hyperoxia

Question 5

2nd stages-once we have ROOP, it is better to sat better

Answer 5

O2 controls VEGF

Question 6

Vascularization of the retina

Answer 6

Fetus: Igf-1 activates VEGF

Question 7

IGF-1

Answer 7

levels increase in the 3rd trimester (immature miss them); large amounts in the amniotic fluid; protein intake increases the levels in preterms; s start proteinearly; ROP linked to poorly nourished infants with protein deficits and worsens ROP

Question 8

1st Phase: Development of ROP

Answer 8

After Birth: retinal development shuts down; room air after birth and more O2 than used to in utero and retinal development shuts down

Question 9

Avascular area becomes quiet and shrinks down and stops because VEGF is decreased because of Increase in O2

Answer 9

lose placenta; lose noursihment

Question 10

2nd Phase: Development of ROP

Answer 10

After ~ 4 weeks, the avascular retina increases its metabolic needs and VEGF is again produced

Question 11

VEGF accumulates until:

Answer 11

ILGF-1 levels reach threshold level reactivating VEGF’s process of retinal vascularization

Question 12

If IGF-1 reached threhold early and VEGF amounts are not excessive, then no ROP

Answer 12

If IGF-1 levels reach threshold late, then VEGF levels will be excessive and ROP will occur

Question 13

excessive VEGF causes out of control angiogenesis

Answer 13

causes balled-up vessels, AV hunts at the body of avascular and vascular parts of the retina and you get a little line, then a ridge, then a BIG ridge with little vessels and fibroblasts hooking into the white part of the eye causing traction with causes detatchment

Question 14

Development of ROP

Answer 14

If ROP develops, it usually occurs between weeks 34-40 weeks after conception

Question 15

WHO gets ROP?

Answer 15

Premature, severity of illness, number of complications

Question 16

Zone 1

central visionis preserved if you have zone one/no ROP in zone 1

Answer 16

causes 80% loss of central vision; thankfully most babies who get ROP are already in zone 2

Question 17

Zones

Answer 17

3 zones moving outward from optic disc

Question 18

Stages 1-5

Answer 18

Clock hours 0-12hrs

Question 19

International classification of ROP:

Answer 19

ROP seen is Zone 1 has the worst prognosis

ROP seen initially in Zone III is mild and recovers fully

Question 20

Stages of ROP

Answer 20

Based on the overproduction of vessels at border of vascularized and avascularized retina

Question 21

Stage 1

Answer 21

Distinct line between vascular and avascular retina

Question 22

Stage 2 ROP

Answer 22

Line has become a ridge (vessels cant cross ridge)

Question 23

Stage 2 with PLUS disease

Answer 23

Plus disease determined by the findings in zone near optic disc

Question 24

Plus Disease

Answer 24

As ROP in periphery becomes more severe, the veins become dilated and arteries become tortous

Question 25

RUSH dusease

Answer 25

ROP in Zone 1 accompanied by severe plus disease: can pregress very rapidly to total retinal detatchment

Question 26

Stage 3 ROP

Answer 26

Vessels now extended BEYOND retina into vitreous

Question 27

Stage 4

Answer 27

Partial retinal detatchment (4a-spares macula; 4b-macula is involved

Question 28

Stage 5

Answer 28

TOTAL RETINAL DETATCHMENT

Question 29

Criteria for intervention

Answer 29

Wait and watch: Zone 1: stage 1 or stage 2 WITHOUT PLUS DISEASE
ZONE II stage 1,2,3 without Plus disease

Question 30

Threshold ROP

Answer 30

untreated threshold ROP progresses to retinal detatchment in 50% of the cases

Question 31

Most infants with ROP undergo regression

Answer 31

Even infants with severe stage 3 ROP can be expected to have good vision if regression occurs without distortio or detachment of the retina

Question 32

Complications of ROP

Answer 32

a late-onset form of glaucoma described in ROP pts when they reach 12-45 yrs

Question 33

All infants meeting ROP criteria need rexamined

Answer 33

6 months, 3 years and then at least yearly

Question 34

Treatment of ROP: Purpose:

Answer 34

Eliminates abnormal BV before they lay down enough scar tissue to produce retinal detatchemtn; desctrction of the remaining avascular retina causes production of VEGF to cease

Question 35

Cryotherapy

Answer 35

Cold ice probe; rarely used

Question 36

Laser therapy

Answer 36

condensation of protein material by controlled use of light rays; conventional laser thx resulted in permanent destruction of vessels in the peripheral retina

Question 37

Intravitreal tr allows for continued vesssel growth into the peripheral retina

Answer 37

inject into vitreous to decrease angiogenic factor, VEGF by rendering it inactive

Question 38

bevacizumab is effective more rapidly than laser

Answer 38

laser: 7-14 days for exsisting VEGF in the vitreous to diminish (ROP to stop getting worse)
Injection imediately stops the effects of VEFG in the perpheral retina andin the vitreous

Question 39

laser vs Bevacizumab:

Answer 39

no need for intubation and ventilation, less need for post op opthal gtts; usually only 1 single injection is needed for each eye; relatively inexpensive; shorter hsopital lenght of stay; myopia (eso severe) does not occur

Question 40

Myopia in ROP

Answer 40

laser detroys factors responsible for development of anterior segment of the retina resulting in steeper curvature of the cornea, increased lense thickness, decreased anterior chamber depth; COKE BOTTLE GLASSES

Question 41

longer follow up (56 wks)

Answer 41

although recurrence of ROP is less with bevac….