RETINOPATHY OF PREMATURITY

Retinopathy of Prematurity (ROP) is a condition effecting the retina in premature infants. As the retina develops, blood vessels grow within it. These vessels begin in the back of the eye, and grow forward. They typically finish forming at about the due date. When a child is born early, these vessels have not yet fully developed.

​Following all infant deliveries, the oxygen level in the blood rises. In premature infants, the higher oxygen levels cause the forming retinal blood vessels to temporarily stop growing. In most infants these vessels eventually begin to grow again and develop normally. In a small number of infants, the vessels begin growing abnormally. This is called ROP. In severe cases of ROP, abnormal vessels grow into the vitreous cavity of the eye. These blood vessels are fragile and may bleed, causing vitreous hemorrhage. Scar tissue may form and pull on the retina causing a retinal detachment. The smaller and more premature the infant is, the more likely ROP is to occur.

Diagnosis

A dilated eye exam is performed on all premature infants at risk of developing ROP. Depending upon the findings at that time, follow up exams are frequently recommended. The equipment used to examine the eye is the same as that used for an adult patient.

Treatment

The vast majority of infants with ROP do not require treatment, because their retinopathy improves on its own. In more advanced cases, laser treatment may be required. When vitreous hemorrhage or retinal detachment develop, vitrectomy or scleral buckling surgery may be required. Medications have recently been developed which stop the growth of abnormal blood vessels and may be effective in treating ROP.

Prognosis

Most cases of ROP are mild and improve on their own. More advanced cases may require laser treatment, intravitreal drug therapy, or surgery to prevent vision loss. Because a delay in treatment may lead to irreversible vision loss, careful screening and follow up is very important for all at risk infants. Children born prematurely are also at risk of developing nearsightedness, lazy eye, crossed eyes, cataract, glaucoma, and retinal detachment. Therefore, evaluation at 6-12 months of age is recommended.