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Retinopathy of Prematurity

Retinopathy of Prematurity

Retinopathy of Prematurity is a type of eye disease that occurs in premature infants. This was first found in the year 1942 and currently accounts for the largest reason for blindness in childhood.

ROP is formed primarily due to the abnormal growth of blood vessels in the Retina. Usually, in a full-term baby, these blood vessels streaming the walls of the retina will have complete growth. These blood vessels feed the Retina.

The eye begins to grow rapidly from 12-16 weeks of pregnancy and completes its growth by 38-42nd week.

In premature babies, in some cases, the growth of these blood vessels stops. After some time, they tend to grow rapidly and abnormally. This abnormal growth leads to bleed or hemorrhaging of the blood vessels.

Leakage of these bloodstreams leads to scar formation on the retina. This eventually puts in a situation of loss the complete vision for the infants.

What is Prematurity?

Before heading into prematurity, let us try to understand what is full-term gestation or pregnancy?

A full-term pregnancy is a duration of 38-42 weeks between LMP (last menstrual period) to the date of delivery.

When a baby born within 36 weeks of gestational or with the weight of fewer than 1250 grams (2.75 Pounds) at the time of birth is termed as prematurity.

Premature babies are like to have this ROP disorder affecting both the eyes. The disease is usually symmetrical.

Statistics on Retinopathy of Prematurity:

  • As per Global data, almost 0.8% of babies are premature.
  • In these premature babies, 57% of infants are likely to be affected by Retinopathy of Prematurity.
  • In which, only 10% of infants will be affected in severe stages (Stage III – V). Only these infants require treatment and the other 90% don’t require any treatment.
  • The infants with ROP stage III+ if untreated have a maximum chance to lose their vision.

Symptoms of Retinopathy of Prematurity:

  • There are no early symptoms found in babies with ROP.
  • The symptoms are found in later stages. They are unusual eye movement, white pupil, vision loss.
  • The best way to diagnose ROP is by Eye Exam/ screening using an indirect Ophthalmoscope or Photographs of the retina.

Stages of Retinopathy of Prematurity:

Basically, ROP is classified by 5 different stages depending on the severity of the disease.

Stage I – The stage where they have mild abnormal blood vessel growth. This category holds major cases with ROP. There is no treatment needed, rather the disease resolves without any progression as moves on.

Stage II – The blood vessel growth will be Moderate. Infants belonging to this stage also don’t require any treatment as Stage I is. Their disease will resolve on its own and will attain normal vision power as their eye grow. If it’s associated with plus disease a close follow up is warranted.

Stage III – Infants with Severe abnormal blood vessel growth will be categorized in Stage III. This stage requires treatment for sure, if left untreated may lead to complete vision loss. Even though, there are few babies who recover their vision in Stage III without any treatments. In this stage, the blood vessels grow towards the center of the eye, rather than growing along the wall of the retina.

Stage IV – Here the retina will be found partially detached from the wall of the eyes. The abnormal blood vessels start leaking and make a scar-like impression. This scar pulls the retina away from the eye’s wall.

Stage V – The infants under this stage will be having a completely detached retina and it’s termed as the end-stage of ROP disease. If the eyes left untreated, the child would have a severe visual impairment.

The majority of children fall under Stage I and Stage II. Few percent of infants fall into Stage III+. Yes, they require treatment to recover their vision.

Treatment Method by R K Eye Clinic:

In R K Eye Clinic, we have a group of professionally trained and highly experienced Ophthalmologists. We always prefer effective treatment and proven treatments like,

  • Laser Therapy
  • Anti VEGF injections
  • Surgical treatment like scleral buckle or vitrectomy

Laser Therapy:

This method is used to tear or burn the periphery of the retina. The laser therapy is allowed on the Infants with ROP with Stage III. Their retina will be filled with abnormal blood vessels and pointing towards the center of the eye. Laser will help by creating an area of retina that no longer requires oxygen requirement thereby reducing or reversing the growth of these abnormal blood vessels.

Cryotherapy:

Cryotherapy is a method by which the Ophthalmologist uses an instrument to freeze the surface of the retina with a definite freezing temperature.

Both Cryotherapy and Laser therapy helps in breaking the peripheral of the retina. This helps in slowing or reversing of abnormal blood vessels. These two treatments are generally performed for Stage III ROP. This is relegated to history at our centre and no longer perform this procedure. Laser treatment has replaced this modality of treatment.

Scleral Buckle:

This method deals with an installation of a silicone band over the eye and tightening them. The vitreous gel present in the silicone band helps in pushing back the scar tissue caused by the leak. This makes the retina to back its original position.

An infant who undergoes this treatment process has to remove the band in a month or within a year. This method is an advanced ROP treatment method and should be taken for Stage IV or V ROP infants.

Vitrectomy:

This is basically performed only for Stage V ROP infants. Vitrectomy helps in removing the vitreous and replaced by saline. While the vitreous is removed, it peels off the scar tissue found. This makes the retina relax and feature back to the eyewall.

Conclusion:

At R K Eye Clinic, we perform excellent Retinopathy of Prematurity screening and treatments for different stages with experienced consultants. In course of time, we have helped many infants to recover from the defects of ROP. Many infants have recovered their vision thanks to the sound screening programs being conducted at various hospitals all over the city. 

We treat ROP at a reasonable cost. The only advice to caretakers of ROP infants is to consults our team of ophthalmologists to diagnose this condition at the earliest.

Early detection and early treatment can help your infant avoid the adverse situations of ROP as detailed in this article.

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