Retinopathy of Prematurity (ROP)
👶 Retinopathy of Prematurity (ROP) is a vasoproliferative disorder of the developing retina seen in preterm, low birth weight infants.
It results from arrested normal retinal vascularisation followed by abnormal vessel growth → fibrosis → tractional retinal detachment → blindness.
📖 About
- Retinal vessels grow from the optic disc towards the ora serrata.
- Reach nasal ora serrata at ~36 weeks, temporal ora serrata at ~40 weeks.
- ROP arises if this process is arrested – typically <32 weeks gestation.
🧬 Aetiology & Risk Factors
- Hyperoxia (often iatrogenic, from O₂ therapy for neonatal RDS) → ↓ growth factor production → arrested vascular growth.
- Hypoxia of peripheral retina (as it becomes metabolically active) → VEGF surge → abnormal neovascularisation.
- Risk factors:
- Prematurity (<28 weeks).
- Birth weight <1500 g.
- Neonatal hyperglycaemia, sepsis, transfusions.
- Fluctuating oxygen saturations (esp. with poor NICU control).
🩺 Clinical Features (Exam)
- White demarcation line separating vascular vs. avascular retina.
- Abnormal, dilated, tortuous retinal vessels (so-called "plus disease").
- Fibrovascular proliferation → traction bands.
- Partial/complete retinal detachment ± foveal involvement.
🔎 Screening & Investigations
- UK guidance: infants <32 weeks gestation or <1500 g birth weight → serial ophthalmology screening.
- First screening: usually by 4–6 weeks chronological age (or 31 weeks corrected gestation, whichever is later).
- Follow-up frequency depends on disease stage and risk.
- Fundoscopy with indirect ophthalmoscope is diagnostic.
💊 Management
- Prevention: Careful oxygen control in NICU (target sats 90–95%).
- Anti-VEGF injections (e.g. bevacizumab) – reduce neovascularisation.
- Laser photocoagulation – ablates avascular peripheral retina → ↓ VEGF stimulus.
- Cryotherapy – historical, now rarely used.
- Vitrectomy for advanced disease/retinal detachment.
📊 Prognosis
- Mild cases may regress spontaneously.
- Advanced disease → tractional retinal detachment → irreversible blindness.
- Even with treatment, survivors may have strabismus, myopia, or amblyopia.
📚 References & Further Reading
