Current understanding and management of retinopathy of prematurity

Abstract

Retinopathy of prematurity is the leading cause of childhood blindness in industrialized countries and is the fifth leading cause of bilateral childhood blindness worldwide. There have been new insights into understanding the factors involved in the pathogenesis of retinopathy of prematurity and related retinal detachment. This review outlines the current recommendations for initiation, frequency, and duration of screening examinations and describes the infants at the highest risk for developing complications from retinopathy of prematurity. The rationale and timing of treatment are also discussed. Infants who undergo early screening and treatment for retinopathy of prematurity have improved long-term functional and structural outcomes compared with those who receive conventional screening and treatment. Patients undergoing surgical repair of retinopathy of prematurity-related detachments (stage 4A, 4B and 5) can have favorable anatomical and functional outcomes. The increased survival of lower birth weight infants has increased the prevalence of aggressive, posterior retinopathy of prematurity that may be unresponsive to conventional treatment. While full understanding of the mechanisms that underlie the formation of retinopathy of prematurity and related detachments is not complete, progress has been made in identifying risk factors, screening of high-risk patients, and optimizing the timing of surgical interventions to improve structural and functional outcomes.