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Retinopathy of Prematurity

(Retrolental Fibroplasia)

by James W. Kendig, MD, Ursula Nawab, MD

Retinopathy of prematurity is a bilateral disorder of abnormal retinal vascularization in premature infants, especially those of lowest birth weight. Outcomes range from normal vision to blindness. Diagnosis is by ophthalmoscopy. Treatment of severe disease may include cryotherapy, laser photocoagulation, or bevacizumab; other treatment is directed at complications (eg, retinal detachment).

The inner retinal blood vessels start growing about midpregnancy, but the retina is not fully vascularized until term. Retinopathy of prematurity (ROP) results if these vessels continue their growth in an abnormal pattern, forming a ridge of tissue between the vascularized central retina and the nonvascularized peripheral retina. In severe ROP, these new vessels invade the vitreous. Sometimes the entire vasculature of the eye becomes engorged (plus disease).

Susceptibility to ROP correlates with the proportion of retina that remains avascular at birth. In neonates weighing < 1 kg at birth, ROP occurs in 47 to 80%, and severe ROP occurs in 21 to 43%. The percentage is higher when many medical complications exist (eg, infection, intraventricular hemorrhage [see Intraventricular and/or intraparenchymal hemorrhage], bronchopulmonary dysplasia [see Bronchopulmonary Dysplasia (BPD)]). Excessive (especially prolonged) O 2 therapy increases the risk. However, supplemental O 2 is often needed to adequately oxygenate the infant even though a safe level and duration of O 2 therapy have not been determined.

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