Makindo Medical Notes

👶 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

• Hellström A. et al. Retinopathy of Prematurity, Lancet 2013; 382(9902):1445–1457.
• EyeWiki: Retinopathy of Prematurity
• UK RCPCH ROP Screening Guideline