Retinopathy of Prematurity

What is retinopathy of prematurity?

The eye is often compared to a camera. The front of the eye contains a lens that focuses the images on the inside of the back of the eye. This area, called the retina, is covered with special nerve cells that react to light.

Underneath the retina there is a network of blood vessels. These blood vessels usually grow rapidly in the last few weeks before a baby is born. If the baby is born prematurely, there may be a problem with this growth.

In some premature babies, blood vessels develop in parts of the eye where they do not belong. This can cause scar tissue to form inside the eye. Scar tissue can damage the retina and cause significant loss of vision. This condition is called retinopathy of prematurity.

Most infants who are born about 2 months or more prematurely or have a low birth weight will have some degree of retinopathy of prematurity. Fortunately, the condition is often not serious, does not harm vision and subsides without the need for treatment. In some infants, however, the retinopathy of prematurity will develop very quickly and could cause vision loss or even blindness.

Over the years, doctors have identified many factors that seem to worsen the retinopathy of prematurity, such as the provision of excess oxygen to premature babies. Avoiding these factors has reduced the number of babies with severe retinopathy of prematurity, but has not eliminated the condition.

There is no way to predict which babies will develop the most severe forms of retinopathy of prematurity. That is why it is very important for all babies born at 32 weeks or earlier, weighing less than 1,500 grams at birth or whose neonatologist considers them to be a high risk of being examined by a pediatric ophthalmologist. 

The doctor will use a special instrument to look into the eye at the retina. An important part of this examination is to determine how much of the retina of each eye can be affected by the retinopathy of prematurity.

The doctor will grade the results of the examination on a standard scale of five stages. Stage 1 of retinopathy of prematurity is the least severe form of the condition, and stage 5 is the most severe.

Only a pediatric ophthalmologist can recommend the right treatment for a baby with retinopathy of prematurity.There commended treatment will depend on how severe there tinopathyis.

Stage 1 or 2 retinopathy usually does not require any treatment. Instead, the doctor will most likely schedule frequent eye examinations to make sure that the condition of the newborn does not worsen. It is very important to keep these appointments, because abnormal blood vessels could start to grow at any time.

The doctor may recommend treatment for higher stages of retinopathy of prematurity. The only available treatments are laser or surgical treatments and are performed under general anesthesia.

Procedures for the treatment of retinopathy of prematurity include:

This procedure is used to stop the abnormal growth of blood vessels through the retina. The surgeon focuses a laserbeam onto a small spoton the retina where the blood vessels grow. The Laser beam heats up thatspot, creating a tiny burn in the blood vessels and stopping their growth. In most cases, the abnormal blood vessels will then get smaller and disappear.

When intravitreal bevacizumab infusion (Avastin) was commonly used to treat neovascular age-related macular degeneration (AMD) and diabetic retinopathy, some researchers considered that bevacizumab (Avastin) may also benefit patients with retinopathy of prematurity. It is now accepted that intravitreal injection of bevacizumab is effective in promoting the resolution of retinopathy of prematurity requiring treatment and this regression is often quite dramatic, as it occurs within the first 24 to 48 hours after injection. Several series of cases have reported resolution of retinopathy of prematurity in patients treated with bevacizumab (Avastin) alone or in combination with laser photocoagulation.

In eyes with a large amount of scar tissue and blood vessels, the surgeon may need to remove part of the gel-like fluid that fills most of the inside of the eye. This material is called vitreous fluid, and its removal process is called vitrectomy. In addition to removing the vitreous fluid, the surgeon will also remove the scar tissue that pulls the retina. This should help reduce the chances of retinal detachment and prevent loss of vision.

In the small number of infants who need treatment for retinopathy of prematurity, the treatments usually work well at preventing the loss of vision. The most important thing parents can do to help get the best result for their child is to keep all scheduled appointments and follow the advice of the paediatric ophthalmologist after any treatment.

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