Retinopathy of Prematurity

Abstract

Retinopathy of Prematurity (ROP) is a bilateral proliferative retinopathy affecting premature infants with low birth weight who have been exposed to high concentration of oxygen. The retinopathy was first reported by Terry in 1942. ROP can be seen in 85% to 90% of children of low birth weight when exposed to high concentration of oxygen. The incidence of ROP in India varies between 39-51.9% in low birth weight infants. When excessive oxygenation is used in the nursing of premature infants, ex-utero changes in oxygen tension causes abnormal up or down-regulation of VEGF expression. Dysregulated VEGF expression leads to untimely vasoobliteration 9 or exaggerated vasoproliferation. Retinal arteries and eventually the veins are obliterated inciting a phase neovascularisation and fibrous proliferation resulting in different stages of ROP. The ultimate goals of treatment of threshold ROP are prevention of any retinal detachment or scarring and Optimization of visual outcome Laser has become the instrument of choice. The aim of the treatment is to ablate the entire peripheral avascular retina up to the ora serrata in a near confluent burn pattern .Surgery for stage 4B ROP is performed to minimize retinal distortion and prevent total detachment .The functional goal is ambulatory vision. The collaborative effort involving the paediatrician, neonatologist and the ophthalmologist is required to prevent this preventable cause of blindness in children. Failure to diagnose and treat ROP and its complications in a timely fashion increases the legal exposure of physicians caring for children with ROP