Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP) is a proliferative disorder involving the developing vasculature of premature infants that can result in retinal detachment and blindness. Timely screening for ROP and prompt treatment of severe ROP can decrease the prevalence of unfavorable retinal structural and poor visual outcome. The criteria for treatment of ROP has evolved from classic threshold ROP, as defined in the Multicenter Trial of Cryotherapy for ROP, to type 1 prethreshold ROP, as defined in the Early Treatment of ROP randomized trial, with incremental improvement in the overall treatment outcome. The mode of treatment has also transitioned from the use of cryotherapy to laser photocoagulation. The mouse model of oxygen-induced retinopathy has elucidated the pathogenesis of ROP and led to new interventions and screening approaches. Pharmacotherapy using the intravitreal injection of bevacizumab, an antibody to vascular endothelial growth factor, appears to be superior to laser photocoagulation for type 1 ROP in zone I but equivalent to laser therapy for type 1 ROP in zone II. However, the systemic risks associated with bevacizumab are uncertain. New screening algorithms based on the rate of postnatal growth of at risk infants are being developed in order to reduce the percentage of infants screened while maintaining efficacy. Digital fundus photography has a high degree of accuracy for the detection of treatment warranting ROP. Validation studies for the reliability and accuracy of telemedicine for ROP are under way.