A Narrative Review on Managing Retinopathy of Prematurity: Insights Into Pathogenesis, Screening, and Treatment Strategies.

Abstract

Retinopathy of prematurity (ROP) is a rare proliferative ocular condition that can happen in premature babies (born preterm<36 weeks)or who weigh <1.5 kgat birth (low birth weight babies). ROP is a major cause of childhood blindness. It is a premature diseasesince retina vascularization is completed only by 40 weeks of life. The survivability for preterm infants has increased owing to recent improvements in neonatal care during the past decade. As a result, the prevalence of ROP has risen concurrently. The abnormal development of blood vessels in the retina is the cause of this illness. It occurs in two phases, phases 1 and 2. Most preterm infants weighing <1.5 kg need supplemental oxygen for respiratory support at birth. This leads to the initiation of phase 1 (vasoconstrictive phase). Phase 1 is characterized by loss of maternal-fetal connection and hyperoxia due to supplemental oxygen therapy.Oxygen's vasoconstrictive and obliterative action is primarily observed in developing retinal vessels. The inhibition of vascular endothelial growth factorfollows from this.Phase 2 (vasoproliferative phase) showsthe dilatation and tortuosity of the bigger existing vessels together with neovascularization and proliferation of new vessels into the vitreous when the baby is shifted from respiratory support to room air. Now, the retina gets hypoxic, where the retina becomes more metabolically active but is yetminimally vascularized, leading to VEGF-induced vasoproliferation, which might result in retinal detachment. Patients with ROP face the danger of loss of vision. If correct and quick treatment is not provided, they might land into permanent blindness. Yet, ROP remains one of themost preventablecauses of childhoodblindnessworldwide. Blindness caused by ROP can only be avoided if screening programs are readily available, pertinent, and appropriate.The initial stage in the therapy of ROP is the screening ofpremature neonates. Timely screening and management for ROP is important to avoidthis irreversible loss of vision. The treatment is based on the severity of the disease. Management may include pharmacological interventions like intravitrealand anti-vascular endothelial growth factor and non-pharmacological interventions like laser surgery, vitrectomy, and scleral buckling. We conducted athorough literature search of studies onpathogenesis, risk factors, classification, and various treatment options for retinopathy of prematurity in infants, using a mixture of pertinent keywords.Only those studies published in peer-reviewed journals between 2010 and 2023 and written in English were included.Duplicate studies, unavailable in full-text for free, or studies unrelated to our subject matter were excluded. After thoroughly evaluating the selected studies, the results were synthesized and presented narratively. This article sheds light on the pathogenesis of ROP, particularly its relation to oxygen use, screening, and potential therapeutic management of ROP. Today advances in screening techniques have improved the outcomes for infants with ROP. Still, ongoingresearch is needed to optimize management strategies and reduce the burden of this condition.