Retinopathy of prematurity

PURPOSE OF REVIEW: This review highlights recent advances in basic science and clinical research on retinopathy of prematurity (ROP). RECENT FINDINGS: The modern concept of ROP pathophysiology is discussed, as are studies investigating anti-angiogenic agents for treatment. Results of the largest clinical trials are summarized. Current screening criteria, potential modifications to them, and telephotoscreening are discussed. SUMMARY: ROP is a challenging and involving area of pediatric ophthalmology.     

Retinopathy of prematurity

Over the last decade major advances have been made in the understanding of the pathogenesis and evolution of retinopathy of prematurity (ROP). The increased survival of very small premature infants in modern neonatal intensive care units has led to the resurgence of this potentially blinding disease. ROP appears to be a multifactorial disease, the prevention of which is probably impossible even now, with the most accurate methods of blood gas monitoring and oxygen restriction. In addition to oxygen, there are a number of significant risk factors, such as birth weight and gestational age, ventilator hours, hyper and hypocarbia, hypoxia and acidosis, xanthine therapy and probably bright light. Current data suggest that the level of antioxidants in the immature retina is relatively low and therefore oxygen radicals which accumulate in the preterm baby's retina may play an important role in the pathogenesis of ROP. The treatment of the disease in both its "active" and "cicatricial" stages emphasizes the need for a new classification which could serve as a common international language through which results may be compared. Vitamin E was suggested in some studies to be helpful in preventing the severe stages of the disease, but its efficacy has yet to be proved. Treatment modalities such as photocoagulation, cryotherapy and vitrectomy are being tried as a means of therapy in the more advanced stages of the disease. Preliminary results of a large multicenter study support the efficacy of cryotherapy.     

Retinopathy of prematurity

This review summarizes the knowledge and highlights recent advances in clinical research of retinopathy of prematurity (ROP). This disease is still important, because improvements in neonatal intensive care during the last years have increased the survival of the most immature newborns, but did not diminish the ROP frequency. Ophthalmologic screening and, if applicable, laser treatment at the optimal time for advanced ROP prevents blindness in most cases. The history, classification and the modern concepts of ROP pathophysiology are described. The results of various multicenter treatment trials are summarized. The current German screening guidelines are discussed with the guidelines of other nations. The therapeutic treatment strategies and the treatment results are discussed. The ophthalmologic disorders of former preterm infants, as higher rates of amblyopia, strabismus, and refractive error, are mentioned. Possible future therapies, e. g. anti-angiogenic factors are discussed.     

Retinopathy of prematurity. Surgical technique

Retinal detachment, as the end result of severe retinopathy of prematurity (ROP), continues to account for many cases of blindness. Vitreous surgery can result in retinal reattachment in a significant percentage of these patients. The authors report their current techniques, which are based on improved understanding of the pathoanatomy and experience with more than 100 cases of retinal detachment in ROP treated with vitreous surgery.