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