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Retinopathy of Prematurity (ROP)

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Retinopathy of Prematurity (ROP) is a disease of the eye found in premature babies, particularly those with low birth weight. The disease affects retinal blood vessel causing neovascularization or scarring formation. Clinically, it is proliferative vitreoretinopathy. Although in most cases it disappears by itself, in aggressive cases the disease could progress to severe stage i.e. multiple band-like membranes pull up the retina causing retina detachment and permanent blindness. At this stage children would lose the opportunity to live with normal eyesight.

Risk factors
  • Immature retina is the main cause and associated with prematurity (gestational age less than 32 weeks) and very low birth weight (less than 1,500 grams).
  • Other risk factors which could deteriorate the disease
    • Treatment history e.g. prolonged use of endotracheal intubation, long duration of oxygen supplementation, high concentration of oxygen supply, blood transfusion, infection, etc.
    • Medical history e.g. multiple pregnancy, respiratory distress syndrome (RDS), pregnancy complications, intracerebral hemorrhage, seizures, anemia, shock, hypercapnia, hypocapnia, congenital heart defect, vitamin E deficiency, etc.
    • Abnormal condition of the mother during pregnancy e.g. diabetes, hypertension, etc.
There are 5 stages of the disease from mild to severe:

Stage I:  Partial vascularization with distinct demarcation line.
Stage II:  Ridge develops at demarcation line, stopping normal vascular development.
Stage III:  Blood vessels within ridge grow wildly toward center of eye, and scar tissue develops.
Stage IV:  Scar tissue pulls the retina, causing partial detachment.
Stage V:  Total retina detachment.
 
Babies with high risk groups should have their first retinal check 4-6 weeks after birth and follow up every 1-4 weeks depending upon the result of the first check. Follow up is needed until retinal blood vessels are fully developed. The complete retinal examination can be done when the pupil is fully dilated, mydriatic drug therefore will be applied with great care. Side effects of the mydriatic drug include increased heart rate, abnormal breathing.
 
Basically, treatment is started within 72 hours after the disease is found in the stage III plus. There are many treatment options depending on the severity and doctor’s discretion. Options include:
  1. Cryosurgery.
  2. Laser photocoagulation.
  3. Anti-vascular endothelial growth factor (anti-VEGF) injection which prevents the newly formed blood vessels from penetrating into the vitreous humor, or eliminates new branches of vessels in some cases.
  4. In aggressive cases, vitrectomy and retinal surgery might be needed to fix a retinal detachment.
Even though the disease is not yet in severe stage, other problems could develop after the treatment. That is why ophthalmologists suggest that patients strictly visit him/her as appointed. Problems include:
  1. Short-sightedness/long-sightedness/astigmatic
  2. Strabismus, or misalignment of the eye
  3. Lazy eye
  4. Cataract or glaucoma in young age
  5. Retinal detachment
For children to be completely cured from retinopathy of prematurity, they need periodically eye check in order to prevent any potential complications as mentioned above.
 
Retinopathy of prematurity can be prevented. Before deciding to get pregnant, mothers should go through a health check to make sure they are healthy. To prevent premature birth and/or very low birth weight, mothers should:
  1. Care for herself according to the National Health Recommendation.
  2. Be vaccinated according to the doctor’s suggestion before pregnancy to prevent preventable infectious disease during pregnancy.
  3. Have ante-natal care soon after finding out they are pregnant and stick to the obstetrician’s care until delivery.

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