Eye

Retinopathy of Prematurity

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Retinopathy of Prematurity

  • Eye Exam Indications
  1. Infant birth weight <1300g (Gestational age <30 weeks)
    1. Perform initial Eye Exam at 5 weeks of age
  2. Infant birth weight <1800g (Gestational age <36 weeks)
    1. And Received Supplemental Oxygen
    2. Perform initial Eye Exam at 5-8 weeks of age
  3. Infant with prolonged Supplemental Oxygen exposure
  • Pathophysiology
  1. Retinal vessels develop over a long period of time
    1. Onset at 22 weeks
    2. Starts from Optic Nerve and slowly vascularizes
  2. Vessels are very reactive
    1. Increased oxygen exposure leads to Vasoconstriction
      1. Results in tissue necrosis
      2. Retrolental fibroplasia
      3. Results in vessel proliferation
    2. Increased carbon dioxide leads to vasodilation
  • Risks
  1. Very Premature Infants are at high risk
    1. Difficult to prevent Retinopathy
    2. Retinopathy of Prematurity occurs in 95% at 25 weeks
  2. Risk is very low for older children (unless hyperoxia)
  • Anatomy
  1. Zone 1
    1. Circumferential around Optic Nerve area
    2. Zone 1 changes are predictive of severe Retinopathy
  2. Zone 2
    1. Middle region
  3. Zone 3
    1. Peripheral circumference on Retina
  • Signs
  1. Dilate eyes 30 minutes before exam
    1. Cyclomydril 1 drop each eye
    2. Apply drop twice, 5 minutes apart
  2. Funduscopic Staging of Retinopathy
    1. Stage 1: Demarcation Line
    2. Stage 2: Ridge
    3. Stage 3: Extraretinal fibrovascular proliferation
    4. Stage 4: Retinal Detachment
  • Management
  1. Prevent premature births
  2. Prevent Hyperoxia
  3. Eye Exams every 1-2 weeks (assess for Stage 3)
  4. Laser ablation (or Cryotherapy) indications
    1. Stage 3 Retinopathy of Prematurity
    2. Prevents vessel proliferation and progression
  • Prognosis
  1. Infant >38 weeks (corrected) without Retinopathy
    1. Will not develop Retinopathy of Prematurity
  2. Future Risks
    1. Strabismus
    2. Myopia
    3. Retinal Detachment