1. RETINOPATHY OF PREMATURITY
DR ADNAN

2. Definition
It is a developmental vascular proliferative disorder that occurs in the incompletely vascularized retina of primarily premature infants.
ROP is one of the most common causes of blindness in children.
Retinopathy of prematurity (ROP) was formerly known as retrolental fibroplasia

3. Vascular Development of the Eye
Nasal side
Temporal side

4. RISK FACTORS Prematurity <28 wks Low birth weight<1500g
Prolonged O2 administration birth weight <1250 g-66% <1000 g-82%

5. PATHOGENESIS
At 4-5 months of IU mesenchyme cells grow from the region of disc to periphery.
Nasal retina vascularised at 36 wks ,temporal at 40 wks,shortly after birth.
Vascular precursor tissue susceptible to endothelial cell cytotoxicity.

6. EFFECT OF O2…. Primary-Retinal vasoconstriction & vaso obliteration
Secondary-retinal neovascularisation
VEGF plays a major role.
Other factors-LBW, illness, pCO2 has a role.

7. Pathogenesis
Formation of shunts and its progression decides the staging of the disease.
Shunts –located at demarcation line between vascular & avascular retina.
Premature infant without ROP has anterior ,gray,avascular retina blends with vascular retina.
In ROP-clear demarcation line is seen

8. EXAMINATION
DIRECT OPHTHALMOSCOPY

9. INDIRECT OPHTHALMOSCOPY

11. DILATATION

13. INTERNATIONAL CLASSIFICATION OF ROP
Location
Zone deg circle with Optic Disc as centre & radius 2DD.
Zone 2- from Zone 1 to Nasal Ora Serrata
Zone 3- remaining Temporal Crescent
Extent Number of clock hours of retina involved

14. STAGING OF ACUTE ROP
ZONE 1
Z 2 Z3 OD
FOVEA

15. CLASSIFICATION SEVERITY Stage 1: Demarcation line Stage 2: Ridge
Stage 3: Ridge with extraretinal FVP
Stage 4: Subtotal RD A : Extrafoveal B : RD with foveal involvement
Stage 5 :Total RD with funnel

17. PLUS DISEASE Florid form of acute ROP
Retinal vascular dilation and tortuosity in the posterior pole.
Vitreous haze with pupillary rigidity
Increasing Preretinal & Vitreous haemorrhage
Indicates actively progressing phase of the disease

18. RUSH DISEASE PLUS DISEASE in Zone 1 or 2-has a very rapid progression
THRESHOLD DISEASE
PLUS DISEASE with Zone 1 or 2 ROP
STAGE 3
5 confluent hrs of stage 3 or 8 cumulative hrs of extraretinal neovascularization

21. DIFFERENTIAL DIAGNOSIS
STAGES 1-3 FEVR(Familial exudative vitreo retinopathy) Avascular retina . Neovascularisation develops late . Family history/neg h/o prematurity STAGES 4&5 (causes of RD & Leucocoria) a)RETINOBLASTOMA Family history no prematurity Asymmetrical USG B scan -diagnostic

22. DD..(contd) PERSISTENT HYPERPLASTIC VITREOUS
No h/o prematurity Unilateral Congenital Asso. microcornea microphthalmos USG B-Scan –No RD,stalk frm OD to vitreous

23. Examinaton schedule 42 wks-95% at less risk infants develop ROP
Crucial window period is wks
1st examn.done after 4-6 wks of birth or at wks ,whichever is later
Follow up examn at wkly intervals till retina gets fully vascularised.

24. Follow up.., WEEKLY EXAMINATION ROP Zone 1 less than threshold
ROP Stage 2 with plus disease ROP Zone 3 with or without plus ,not requiring ablation

25. FOLLOW UP..,
1-2 WKLY EXAMINATION ROP Zone 2 but less severe No ROP but incomplete vascularisation in Zone 1
2-3 WKLY EXAMINATION
No ROP but incomplete vascularisation in Zone 2

29. TREATMENT

30. INDICATONS FOR ABLATION
TYPE 1 ROP
Zone 1 ROP with plus & stages 1,2,3
Zone 2 ROP with plus & stages 2&3.
Stage 3 without plus disease
TYPE 2 ROP-(WAIT &WATCH)
Zone 1 – Stage 1 or 2 without plus
Zone 2 - Stage 3 without plus

31. TREATMENT contd., STAGE 4 Scleral buckling with vitrectomy
STAGE Vitrectomy+release of FVP + other
re-attachment procedures

33. CRYOTHERAPY

34. LASER

35. ANTI VEGF

40. THANK YOU