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Published in: Indian Journal of Pediatrics 4/2012

01-04-2012 | Symposium on AIIMS Protocols in Neonatology

Retinopathy of Prematurity

Authors: Deepak Chawla, Ramesh Agarwal, Ashok Deorari, Vinod K. Paul, Parijat Chandra, Rajvardhan V. Azad

Published in: Indian Journal of Pediatrics | Issue 4/2012

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Abstract

Retinopathy of prematurity (ROP) occurs due to abnormal proliferation of retinal vessels. The most important risk factors which predispose to development of ROP include oxygen therapy, anemia needing blood transfusion, sepsis and apnea. Very low birth weight neonates, those born at ≤32 week of gestation and other preterm neonates with risk factors must be screened for ROP. As a general rule first screening should be done at 1 month of postnatal age. If screening detects ROP not needing treatment follow up should be planned according to location and stage of ROP. Better visual outcomes are observed with earlier treatment at lower threshold. Peripheral retinal ablation with diode laser under adequate analgesia and sedation is the preferred method for treatment of severe ROP. Guidelines regarding the procedure of dilatation, ophthalmic examination and treatment (if required) have been provided in the protocol. Close co-operation between the ophthalmologist and neonatologist is essential for successful management of ROP.
Literature
1.
go back to reference Flynn JT. The premature retina: a model for the in vivo study of molecular genetics? Eye. 1992;6:161–5.PubMedCrossRef Flynn JT. The premature retina: a model for the in vivo study of molecular genetics? Eye. 1992;6:161–5.PubMedCrossRef
2.
go back to reference Kushner BJ, Essner D, Cohen IJ, Flynn JT. Retrolental fibroplasia II. Pathologic correlation. Arch Ophthalmol. 1977;95:29–38.PubMedCrossRef Kushner BJ, Essner D, Cohen IJ, Flynn JT. Retrolental fibroplasia II. Pathologic correlation. Arch Ophthalmol. 1977;95:29–38.PubMedCrossRef
3.
go back to reference Chan-Ling T, Tout S, Hollander H, Stone J. Vascular changes and their mechanisms in the feline model of retinopathy of prematurity. Invest Ophthalmol Vis Sci. 1992;33:2128–47.PubMed Chan-Ling T, Tout S, Hollander H, Stone J. Vascular changes and their mechanisms in the feline model of retinopathy of prematurity. Invest Ophthalmol Vis Sci. 1992;33:2128–47.PubMed
4.
go back to reference Chan-Ling T, Gock B, Stone J. The effect of oxygen on vasoformative cell division. Evidence that ‘physiological hypoxia’ is the stimulus for normal retinal vasculogenesis. Invest Ophthalmol Vis Sci. 1995;36:1201–14.PubMed Chan-Ling T, Gock B, Stone J. The effect of oxygen on vasoformative cell division. Evidence that ‘physiological hypoxia’ is the stimulus for normal retinal vasculogenesis. Invest Ophthalmol Vis Sci. 1995;36:1201–14.PubMed
5.
go back to reference Chaudhari S, Patwardhan V, Vaidya U, Kadam S, Kamat A. Retinopathy of prematurity in a tertiary care center—incidence, risk factors and outcome. Indian Pediatr. 2009;46:219–24.PubMed Chaudhari S, Patwardhan V, Vaidya U, Kadam S, Kamat A. Retinopathy of prematurity in a tertiary care center—incidence, risk factors and outcome. Indian Pediatr. 2009;46:219–24.PubMed
6.
go back to reference Charan R, Dogra MR, Gupta A, Narang A. The incidence of retinopathy of prematurity in a neonatal care unit. Indian J Ophthalmol. 1995;43:123–6.PubMed Charan R, Dogra MR, Gupta A, Narang A. The incidence of retinopathy of prematurity in a neonatal care unit. Indian J Ophthalmol. 1995;43:123–6.PubMed
7.
go back to reference Gupta VP, Dhaliwal U, Sharma R, Gupta P, Rohatgi J. Retinopathy of prematurity—risk factors. Indian J Pediatr. 2004;71:887–92.PubMedCrossRef Gupta VP, Dhaliwal U, Sharma R, Gupta P, Rohatgi J. Retinopathy of prematurity—risk factors. Indian J Pediatr. 2004;71:887–92.PubMedCrossRef
8.
go back to reference Maheshwari R, Kumar H, Paul VK, Singh M, Deorari AK, Tiwari HK. Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi. Natl Med J India. 1996;9:211–4.PubMed Maheshwari R, Kumar H, Paul VK, Singh M, Deorari AK, Tiwari HK. Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi. Natl Med J India. 1996;9:211–4.PubMed
9.
go back to reference Aggarwal R, Deorari AK, Azad RV, et al. Changing profile of retinopathy of prematurity. J Trop Pediatr. 2002;48:239–42.PubMedCrossRef Aggarwal R, Deorari AK, Azad RV, et al. Changing profile of retinopathy of prematurity. J Trop Pediatr. 2002;48:239–42.PubMedCrossRef
10.
go back to reference Dutta S, Narang S, Narang A, Dogra M, Gupta A. Risk factors of threshold retinopathy of prematurity. Indian Pediatr. 2004;41:665–71.PubMed Dutta S, Narang S, Narang A, Dogra M, Gupta A. Risk factors of threshold retinopathy of prematurity. Indian Pediatr. 2004;41:665–71.PubMed
11.
go back to reference Rekha S, Battu RR. Retinopathy of prematurity: incidence and risk factors. Indian Pediatr. 1996;33:999–1003.PubMed Rekha S, Battu RR. Retinopathy of prematurity: incidence and risk factors. Indian Pediatr. 1996;33:999–1003.PubMed
12.
go back to reference Gopal L, Sharma T, Ramachandran S, Shanmugasundaram R, Asha V. Retinopathy of prematurity: a study. Indian J Ophthalmol. 1995;43:59–61.PubMed Gopal L, Sharma T, Ramachandran S, Shanmugasundaram R, Asha V. Retinopathy of prematurity: a study. Indian J Ophthalmol. 1995;43:59–61.PubMed
13.
go back to reference Varughese S, Jain S, Gupta N, Singh S, Tyagi V, Puliyel JM. Magnitude of the problem of retinopathy of prematurity. experience in a large maternity unit with a medium size level-3 nursery. Indian J Ophthalmol. 2001;49:187–8.PubMed Varughese S, Jain S, Gupta N, Singh S, Tyagi V, Puliyel JM. Magnitude of the problem of retinopathy of prematurity. experience in a large maternity unit with a medium size level-3 nursery. Indian J Ophthalmol. 2001;49:187–8.PubMed
14.
go back to reference Sharma P. DM dissertation: Risk factors for severe retinopathy of prematurity in preterm low birth weight neonates Department of Pediatrics. New Delhi: All India Institute of Medical Sciences 2009 (Submitted for publication to Indian Journal of Pediatrics). Sharma P. DM dissertation: Risk factors for severe retinopathy of prematurity in preterm low birth weight neonates Department of Pediatrics. New Delhi: All India Institute of Medical Sciences 2009 (Submitted for publication to Indian Journal of Pediatrics).
15.
go back to reference Saunders RA, Donahue ML, Christmann LM, et al. Racial variation in retinopathy of prematurity. The cryotherapy for retinopathy of prematurity cooperative group. Arch Ophthalmol. 1997;115:604–8.PubMedCrossRef Saunders RA, Donahue ML, Christmann LM, et al. Racial variation in retinopathy of prematurity. The cryotherapy for retinopathy of prematurity cooperative group. Arch Ophthalmol. 1997;115:604–8.PubMedCrossRef
16.
go back to reference Hellstrom A, Hard AL, Engstrom E, et al. Early weight gain predicts retinopathy in preterm infants: new, simple, efficient approach to screening. Pediatrics. 2009;123:e638–45.PubMedCrossRef Hellstrom A, Hard AL, Engstrom E, et al. Early weight gain predicts retinopathy in preterm infants: new, simple, efficient approach to screening. Pediatrics. 2009;123:e638–45.PubMedCrossRef
17.
go back to reference Hellstrom A, Ley D, Hansen-Pupp I, et al. New insights into the development of retinopathy of prematurity—importance of early weight gain. Acta Paediatr 2010;99:502–8. Hellstrom A, Ley D, Hansen-Pupp I, et al. New insights into the development of retinopathy of prematurity—importance of early weight gain. Acta Paediatr 2010;99:502–8.
18.
go back to reference The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–99. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–99.
19.
go back to reference Azad R, Chandra P, Patwardhan SD, Gupta A. Importance of the ‘third criterion’ for retinopathy of prematurity screening in developing countries. J Pediatr Ophthalmol Strabismus. 2009;46:332–4.PubMedCrossRef Azad R, Chandra P, Patwardhan SD, Gupta A. Importance of the ‘third criterion’ for retinopathy of prematurity screening in developing countries. J Pediatr Ophthalmol Strabismus. 2009;46:332–4.PubMedCrossRef
20.
go back to reference Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2006;117:572–576. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2006;117:572–576.
21.
go back to reference Sun X, Lemyre B, Barrowman N, O’Connor M. Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review. Acta Paediatr. 2010;99:329–34.PubMedCrossRef Sun X, Lemyre B, Barrowman N, O’Connor M. Pain management during eye examinations for retinopathy of prematurity in preterm infants: a systematic review. Acta Paediatr. 2010;99:329–34.PubMedCrossRef
22.
go back to reference Kemper AR, Wallace DK, Quinn GE. Systematic review of digital imaging screening strategies for retinopathy of prematurity. Pediatrics. 2008;122:825–30.PubMedCrossRef Kemper AR, Wallace DK, Quinn GE. Systematic review of digital imaging screening strategies for retinopathy of prematurity. Pediatrics. 2008;122:825–30.PubMedCrossRef
23.
go back to reference Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121:1684–94.PubMedCrossRef Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121:1684–94.PubMedCrossRef
24.
go back to reference Finer N, Leone T. Oxygen saturation monitoring for the preterm infant: the evidence basis for current practice. Pediatr Res. 2009;65:375–80.PubMedCrossRef Finer N, Leone T. Oxygen saturation monitoring for the preterm infant: the evidence basis for current practice. Pediatr Res. 2009;65:375–80.PubMedCrossRef
25.
go back to reference Flynn JT, Bancalari E, Snyder ES, et al. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity. N Engl J Med. 1992;326:1050–4.PubMedCrossRef Flynn JT, Bancalari E, Snyder ES, et al. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity. N Engl J Med. 1992;326:1050–4.PubMedCrossRef
26.
go back to reference Castillo A, Sola A, Baquero H, et al. Pulse oxygen saturation levels and arterial oxygen tension values in newborns receiving oxygen therapy in the neonatal intensive care unit: is 85% to 93% an acceptable range? Pediatrics. 2008;121:882–9.PubMedCrossRef Castillo A, Sola A, Baquero H, et al. Pulse oxygen saturation levels and arterial oxygen tension values in newborns receiving oxygen therapy in the neonatal intensive care unit: is 85% to 93% an acceptable range? Pediatrics. 2008;121:882–9.PubMedCrossRef
27.
go back to reference Tin W, Milligan DW, Pennefather P, Hey E. Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2001;84:F106–10.PubMedCrossRef Tin W, Milligan DW, Pennefather P, Hey E. Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2001;84:F106–10.PubMedCrossRef
28.
go back to reference Chow LC, Wright KW, Sola A. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics. 2003;111:339–45.PubMedCrossRef Chow LC, Wright KW, Sola A. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics. 2003;111:339–45.PubMedCrossRef
29.
go back to reference Askie LM, Henderson-Smart DJ, Irwig L, Simpson JM. Oxygen-saturation targets and outcomes in extremely preterm infants. N Engl J Med. 2003;349:959–67.PubMedCrossRef Askie LM, Henderson-Smart DJ, Irwig L, Simpson JM. Oxygen-saturation targets and outcomes in extremely preterm infants. N Engl J Med. 2003;349:959–67.PubMedCrossRef
30.
go back to reference Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics. 2000;105:295–310. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics. 2000;105:295–310.
31.
go back to reference Brion LP, Bell EF, Raghuveer TS. Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2003:CD003665. Brion LP, Bell EF, Raghuveer TS. Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2003:CD003665.
32.
go back to reference Micieli JA, Surkont M, Smith AF. A systematic analysis of the off-label use of bevacizumab for severe retinopathy of prematurity. Am J Ophthalmol. 2009;148:536–43. e532.PubMedCrossRef Micieli JA, Surkont M, Smith AF. A systematic analysis of the off-label use of bevacizumab for severe retinopathy of prematurity. Am J Ophthalmol. 2009;148:536–43. e532.PubMedCrossRef
Metadata
Title
Retinopathy of Prematurity
Authors
Deepak Chawla
Ramesh Agarwal
Ashok Deorari
Vinod K. Paul
Parijat Chandra
Rajvardhan V. Azad
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Indian Journal of Pediatrics / Issue 4/2012
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-010-0279-7

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