The First Preclinical Angiospastic Phase of Retinopathy (Оphthalmopathy) of Prematurity

Abstract

Retinopathy (ophthalmopathy) of premature infants (ROP) continues to be one of the complex and unresolved problems of pediatric ophthalmology, giving a high percentage of visual disability. ROP is a vasoproliferative disease and occurs in premature infants with a frequency of 16 to 40% of cases. Every year, about 15 million premature babies are born in the world, while 32,300 of them remain blind or with residual vision due to ROP. Despite the success of pediatric ophthalmology, every 5 children with retinopathy of prematurity have low vision or blindness. Moreover, some patients by the age of 25-35 also lose their eyesight from the effects of retinopathy of prematurity. The power of the proliferative process in retinopathy, the speed and irreversibility of its development often plunges pediatric ophthalmic surgeons into despondency and pessimism. The lack of sufficient knowledge still keeps this problem important for ophthalmology. It's time to call retinopathy of prematurity a «tragedy of our time». Today, there are two phases in the course of retinopathy of prematurity: 1) active and 2) regressive or scarring. We propose to single out the first preclinical angiospastic phase of ROP development, which is not deservedly forgotten by ophthalmologists. Most ophthalmologists focus on the active or scar phase of ROP, but the preclinical phase (РР), which lasts about 1 month, attracts almost little attention of ophthalmologists. Meanwhile, during the first month of a premature baby's life, ophthalmologists usually take a wait-and-see attitude and do not carry out treatment, although at this time there are crisis morphofunctional changes in the eye. In the first preclinical, angiospastic phase, the pathogenesis of pathological angiogenesis is formed and new mechanisms of ROP prevention are determined. A thorough study of it will allow a radical revision of the strategy and tactics of diagnosis and treatment will enable early detection and treatment of ROP by stages. The lack of due attention to this phase delays the development of screening informative research schemes during this period, the search for the most significant risk factors for the development of ROP, the search for new methods of prevention and treatment.