Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants. It occurs when the retina develops abnormally in extremely premature infants, usually those born before 32 weeks gestation or weighing less than 1500g. ROP develops in five stages based on the severity of abnormal blood vessel growth in the retina. Treatment is usually required when ROP reaches threshold stage 3 or higher in certain zones. Management involves screening, close monitoring according to international classification guidelines, and timely treatment such as laser photocoagulation when indicated to prevent vision loss. ROP can cause lifelong visual complications so prevention through optimizing neonatal care remains the ultimate goal.

1. ‫بسم ا الرحمن الرحيم‬
‫‪ROP‬‬

2. Retinopathy of prematurity
http://oftalmologo.bravepages.co
m/Leucocoria%201.jpg
By
DR/Mohamed Abdel-Aziz
M.SC(ophthalmology)
www.nyee.edu/images/ar038.jpg

3. ROP-Definition
Retinopathy
of
prematurity
(ROP):
Is an ischemic retinopathy of
premature and low-birth-weight
infants.

4. ROP : Risk Factors
 Gestational age: less than 32
weeks
 Birth weight: less than 1500 gm
 Oxygen therapy : Excessive
oxygen use

5. Retinal vascularization
Nasal side
Temporal side

6. Timing of vascularization of the peripheral retina

7. ROP -Classification
-Classificatio

8. International ClassificationConceptual Overview
 Zone : describes the extent of
vascularization.
 Stage : describes the degree of vascular
pathology.
 Sectors : Clock hours used to quantify the
circumferential extent pathology.
 Plus Disease : describes the activity of the
disease.

9. International Classification
– Zones
 Zones: Zone 1 is posterior, Zone 2 is equatorial
and Zone 3 is anterior.
 Zone 1 – High Risk
 Zone 2 – Intermediate Risk
 Zone 3 – Low Risk

10. Zone 3
Zone 2
Zone 1

11. ROP – Classification – Zones
12
12
I
9
III
I
3
II
9
II
I
III
Ora
serrata
Macula
6
Right eye
6
Optic disc
Left eye
3

12. International Classification-Stages
 Stage 1 – Demarcation Line – Low Risk
 Stage 2 – Ridge --Intermediate Risk
 Stage 3 – Fibrovascular proliferation -- High
Risk
 Stage 4 – Partial Retinal Detachment
 Stage 5 – Total Retinal Detachment

13. ROP Classification-Stages
Stage 1. Demarcation
line
between
the
normal retina (left)
and
the
nonvascularized
retina
(right).

14. ROP Classification- Stages
 Stage 2 - ridge (R) of
scar tissue and new
vessels in place of the
demarcation line. The
white line now has
width and height, and
occupies some volume.
 Small tufts of new
vessels ("popcorn
vessels")

15. ROP Classification-Stages
 Stage 3 - Increased size
of the vascular ridge ,
with growth of fibrovascular tissue on the
ridge and extending out
into the vitreous.
 Fibrous scar tissue is
beginning to form in this
stage, with attachments
between the vitreous gel
and
the
ridge.

16. ROP Classification-Stages
 Stage 4 - Partial retinal
detachment.
 Stage 4A - detachment does
not include the macula, and
the vision may be good.
 In Stage 4B - macula is
detached, and the visual
potential is markedly
decreased.
 Stage 5 - Complete retinal
detachment.

17. International Classification
—Stages--Sectors
 Clock hours refer to 30 degree sectors
around the eye.

18. 12
1
Zone 3 Sectors = 30 degrees
2
Zone 2
3
Zone 1
Pathology
described by
clock hours
e.g. stage 3
from 2-3

19. -Plus disease
 Posterior arterial tortuosity and
venous dilation
 Iris vessel dilation and rigidity
 Vitreous haze

20. Plus Disease

21. Stage 1

22. Stage 1

23. Stage 2

24. Stage 2 Popcorn

25. Stage 3

26. Stage 3 Moderate

27. Stage 3 Moderate

28. Stage 3 Moderate

29. Stage 3 Severe

30. Stage 3 Severe

31. Stage 4B

32. Stage 4B

33. Stage 5

34. Stage 5

35. ROP - Management
Managemen

36. ROP - Management
 PREVENTION Prevent preterm labor.
(Optimal) minimum use of oxygen.
Prevention of complications.

37. ROP - Management
 SCREENING
All infants < 34 wks gestational age
AND < 1500 g birth weight are screened
between 4-6 weeks of age.

38. Treatment Criteria
 Treat when threshold ROP is reached.

Threshold ROP:
 5 contiguous clock hours or 8 total clock hours of stage 3
and plus disease in zone 1 or 2.

39. ETROP Recommendations
Stage 1
2
Plus
<48hr
Treat
<48hr
Stage 2
Treat
<48hr
Treat
<48hr
Follow
No Change
Stage 2
Follow
weekly
Follow
twice weekly
Stage 1
No Plus
Treat
Stage 3
Z
o
n
e
twice weekly
Stage 1
Plus
Follow
Stage 3
1
Stage 2
Stage 1
No Plus
twice weekly
Stage 3
Z
o
n
e
Follow
Follow
No Change
Stage 2
Treat
<48hr
Stage 3
Treat
<48hr

40. Treatment Options
 Cryotherapy
 Laser photocoagulation – standard treatment
 Surgical interventions
Scleral buckling
Vitrectomy

41. New treatment options for ROP
 Avastin alone for ROP stage 3 may become
primary treatment replacing LASER therapy (Helen
et al.,2009).
 Recently ,chen et al., report in a retrospective study
effective outcomes using trans-scleral diode
laser instead of transpupillary laser treatment
for threshold ROP(Chen et al.,2011)

42. LASER therapy for Zone I ROP, macular
dragging and 17 diopters of myopia
Intravitreal Avastin for Zone I ROP, NO
macular dragging nor myopia

43. Long Term Complications of ROP
Retinal Dragging
and Folds
Others:
Glaucoma
Late onset Retinal Detachment
Significant myopia
Anisometropia
Strabismus
Amblyopia

44. Who ?
1. < 28 weeks gestation or
2. < 1500 gms or
3. > 1500 gms if unstable
REMEMBER THIS !!!

45. When ?
 Examine 4 –6 weeks after birth
REMEMBER THIS !!!

46. Conclusion
 Ultimate prevention = prevent premature
births.
 ROP is a lifelong disease with sequelae
manifesting into the 2nd decade.
 Surgical intervention preserves vision in
ROP-related retinal detachment esp. before
macular detachment.