High-Risk Newborn

Retinopathy of Prematurity

What is retinopathy of prematurity?

Retinopathy of prematurity (ROP) is a disorder of the blood vessels of the retina (the light sensitive part of the eye). ROP is most common in premature babies. Generally, the more premature the baby and the lower the birthweight, the greater the risk for developing ROP. This disorder has in the past been called retrolental fibroplasia.

What causes retinopathy of prematurity?

The exact mechanism of ROP is not fully understood. The retina is the thin layer of light-sensitive nerve fibers and cells that covers the inside and back of the eye. The blood vessels of the retina are not completely developed until the baby reaches full term. When a baby is born prematurely, the blood vessels may not have fully developed. They may have growth of abnormal blood vessels, or damage and scarring of existing blood vessels in the retina. The scarring and bleeding can lead to retinal scarring or detachment from the back of the eye, resulting in vision loss.

Why is retinopathy of prematurity a concern?

ROP occurs in 16 percent of all premature births. Each year in the US, over 2,100 children experience the complications of ROP. There are five stages of ROP, from a mild Stage 1 to severe Stage 5 when the retina detaches in the eye. Babies with Stage 1 and 2 ROP are called prethreshold, and those with Stages 3 through 5 are called threshold. About 90 percent of babies with Stage 1 and 2 ROP show improvement without treatment. However, about half of babies with Stage 3 and most of those with Stage 4 may develop serious eye damage. Each year, approximately 400 to 600 children are blinded by ROP.

Management of retinopathy of prematurity:

In 2001, the American Academy of Pediatrics (AAP) developed guidelines for a screening program to identify babies at risk for ROP. These guidelines include the following:

• at least two eye examinations, by a qualified ophthalmologist, for very low birthweight or premature babies (less than 28 weeks gestational age), as well as other premature or low birthweight babies have unstable conditions
  
  
• eye examination should be done at 4 to 6 weeks of age, or when the baby reaches 31 to 33 weeks gestational age
  
  
• follow-up eye examinations at appropriate times
  
  
• considering babies with severe categories of ROP for treatment within 72 hours of diagnosis

Treatment of retinopathy of prematurity:

Early diagnosis of damage is important in the treatment of ROP. Babies who develop severe ROP may benefit from a treatment called cryopexy that uses freezing to stop further damage from occurring. Another treatment uses laser photocoagulation to create small burns, thus, producing scars. These scars seal the borders of the retina helping prevent detachment. Surgical treatment may be used if the retina detaches.

Prevention of retinopathy of prematurity:

Preventing premature births is the key to preventing ROP. However, research is ongoing to find ways to treat this and other problems of premature babies.