Retinopathy of Prematurity
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Occurs in babies born prematurely (at/before 30-32 weeks' gestation) or those with low birth weight (<1.5kg)
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those with systemic disease e.g. anaemia or sepsis at higher risk​
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Screening of at-risk babies
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All babies born <30-32weeks or with low birth weight
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Screened at birth, then every 1-3 weeks from 4-7 weeks old by paediatric ophthalmologist
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Pupils dilated & indirect ophthalmoscopy performed to examine retina
Causes of ROP
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Normally the retinal vasculature is not fully developed at birth
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Vessels normally develop from centre of optic disc and grow out along surface of retina into periphery
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In retinopathy of prematurity there is abnormal retinal vasculature development
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Associated with oxygen therapy - hyperoxia drives disease in early stages
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precise mechanism unknown
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Complications
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The development of abnormal blood vessels can bleed and lead to retinal fibrosis (scarring)
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Fibrous scarring bands put tension on the retina, pulling it and resulting in retinal detachment
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this can cause blindness​
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Higher rates of strabismus, refractive error and amblyopia in ROP
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Treatment
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Most cases of ROP resolve spontaneously
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Treatment given when there is a risk of complications (see above)
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Involves laser ablation therapy to peripheral retina where there are no vessels
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By photocoagulating peripheral ischaemic retina, ischaemic stimulus to vascular growth vessels is removed i.e. reduces growth of further, new vessels on retina
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Sometimes a role for intravitreal anti-VEGF injections
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References
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James, B., Bron, A. J. and Parulekar, M. V. (2016) Lecture Notes Ophthalmology. 12th edn. Nashville, TN: John Wiley & Sons (Lecture Notes)
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Salmon, J. F. (2019) Kanski’s clinical ophthalmology. 9th edn. London, England: Elsevier Health Sciences.