Orris

Retinopathy of prematurity

Reading File
Finding Sources
Finding Sources
Searching PubMed

"retinopathy of prematurity"

Searching the Web

retinopathy of prematurity AAO screening treatment anti-VEGF laser current guideline

Reading File
Reading File
Reading File
Searching Images

retinopathy of prematurity fundus photograph stages plus disease diagram

Reading Web Page

https://pmc.ncbi.nlm.nih.gov/articles/PMC8697761

Retinopathy of Prematurity (ROP)

Retinopathy of prematurity is a vasoproliferative disorder of the incompletely vascularized retina in premature infants. It can regress spontaneously, but severe disease can cause tractional retinal detachment and permanent visual loss.

Pathogenesis

Retinal vascularization normally completes near term. In a premature infant:
  1. Early hyperoxic phase: supplemental oxygen and loss of the intrauterine environment suppress retinal VEGF, causing arrested or regressed normal vascular growth.
  2. Later hypoxic phase: as the avascular retina matures, hypoxia increases VEGF and causes abnormal neovascularization, which may extend into the vitreous.
  3. Fibrovascular contraction can produce tractional retinal detachment.
  • Kanski's Clinical Ophthalmology, 10th ed., p. 562
  • Harriet Lane Handbook, 23rd ed., p. 665

Important risk factors

  • Lower gestational age
  • Very low birth weight
  • Excessive or fluctuating oxygen exposure
  • Severe neonatal illness, such as sepsis, respiratory distress, anemia, poor postnatal weight gain, or prolonged cardiorespiratory support

Classification: ICROP

ROP is recorded by zone, stage, extent in clock-hours, and plus disease.
Zones
  • Zone I: posterior retina around the optic disc and macula. Disease here is high risk.
  • Zone II: extends from zone I to the nasal ora serrata.
  • Zone III: residual peripheral temporal crescent.
Stages
  1. Stage 1: demarcation line between vascular and avascular retina.
  2. Stage 2: elevated ridge.
  3. Stage 3: extraretinal fibrovascular proliferation.
  4. Stage 4: partial tractional retinal detachment.
    • 4A: extrafoveal
    • 4B: fovea involved
  5. Stage 5: total retinal detachment.
Plus disease: abnormal posterior retinal vascular dilation and tortuosity. It signals more severe active disease. “Pre-plus” is an intermediate degree of vascular abnormality.
  • Kanski's Clinical Ophthalmology, 10th ed., p. 562

Screening

A dilated retinal examination is generally indicated for:
  • Infants born at ≤30 weeks' gestation, or
  • Birth weight <1500 g, and
  • Selected larger or more mature infants with an unstable clinical course or substantial cardiorespiratory support.
A commonly used schedule is:
  • For infants born ≤27 weeks, first examination at 31 weeks postmenstrual age
  • For infants born ≥28 weeks, first examination at about 4 weeks chronological age
Screening schedules and eligibility should follow the local neonatal and ophthalmology protocol.
  • Harriet Lane Handbook, 23rd ed., p. 665

Treatment

Treatment is directed at Type 1 ROP, classically:
  • Zone I, any stage with plus disease
  • Zone I, stage 3 with or without plus disease
  • Zone II, stage 2 or 3 with plus disease
Main treatments:
  • Laser photocoagulation of the avascular peripheral retina: an established definitive treatment.
  • Intravitreal anti-VEGF therapy such as bevacizumab, ranibizumab, or aflibercept: often used especially in posterior Zone I disease or aggressive ROP. It preserves peripheral retina but needs very prolonged surveillance because late reactivation can occur and systemic developmental safety remains under study.
  • Vitrectomy or retinal surgery: for selected stage 4 or 5 tractional retinal detachments.
Current ICROP-3 terminology also recognizes aggressive posterior ROP, which may progress rapidly and requires urgent specialist assessment. The AAO ICROP-3 overview discusses the updated classification and the need for long follow-up after anti-VEGF treatment.

Outcomes and follow-up

Even after regression or treatment, children require visual follow-up for:
  • Myopia
  • Strabismus
  • Amblyopia
  • Glaucoma
  • Late retinal detachment and other retinal abnormalities
Untreated severe ROP may result in irreversible blindness. Goldman-Cecil Medicine, 27th ed., p. 863.

Key exam points

  • Prematurity + low birth weight + oxygen exposure are the classic association.
  • Pathology is driven by abnormal retinal VEGF signaling after interrupted vascular development.
  • Stage 3 with plus disease is a major treatment warning.
  • Laser treats avascular retina; anti-VEGF requires extended monitoring for late recurrence.
  • Screening prevents avoidable blindness.
Recent systematic reviews have focused mainly on telemedicine screening and biomarkers rather than changing the core clinical classification or treatment framework (PMIDs 41951053 and 38571701).
This is a shared conversation. Sign in to Orris to start your own chat.