II. 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

III. 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

IV. 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)

V. 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

VI. 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

VII. 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

VIII. 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

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Retinopathy of Prematurity (C0035344)

Definition (NCI) A bilateral retinopathy characterized by neovascularization, scarring, retinal detachment, and eventually blindness. It may be mild or severe. It occurs in babies born prematurely. Causes include oxygen toxicity and hypoxia.
Definition (MSH) A bilateral retinopathy occurring in premature infants treated with excessively high concentrations of oxygen, characterized by vascular dilatation, proliferation, and tortuosity, edema, and retinal detachment, with ultimate conversion of the retina into a fibrous mass that can be seen as a dense retrolental membrane. Usually growth of the eye is arrested and may result in microophthalmia, and blindness may occur. (Dorland, 27th ed)
Definition (CSP) bilateral retinopathy typically occurring in premature infants treated with high concentrations of oxygen; characterized by vascular dilation, proliferation, and tortuosity, edema, and retinal detachment with ultimate conversion of the retina into a fibrous mass; usually growth of the eye is arrested and may result in microophthalmia; blindness may occur.
Concepts Disease or Syndrome (T047)
MSH D012178
ICD9 362.20, 362.21
ICD10 H35.1 , H35.10, H35.17
SnomedCT 155110004, 74277007, 415297005
LNC LA16303-2
English Fibroplasias, Retrolental, Prematurity Retinopathies, Prematurity Retinopathy, Retrolental Fibroplasia, Retrolental Fibroplasias, Fibroplasia, Retrolental, RETROLENTAL FIBROPLASIA, ROP - Retinopathy prematurity, RETINOPATHY OF PREMATURITY, premature retinopathy, retinopathy of prematurity, retinopathy of prematurity (diagnosis), Retinopathy of prematurity, unspecified, retrolental fibroplasia (diagnosis), retrolental fibroplasia, Retinoph prematurity NOS, Retinopathy of prematurity NOS, Retinopathy of Prematurity [Disease/Finding], rlf, prematurity retinopathy rop, fibroplasia retrolental, prematurity retinopathy, retinopathy premature, prematurity of retinopathy, retinopathy prematurity, Retrolental fibroplasia (disorder), fibroplasia; retrolental, prematurity; retinopathy, retinopathy; prematurity, Retinopathy of Prematurity, Terry's syndrome, Retrolental fibroplasia, ROP, ROP - Retinopathy of prematurity, Retinopathy of prematurity, RLF - Retrolental fibroplasia, Retinopathy of prematurity (disorder)
Portuguese FIBROPLASIA RETROLENTICULAR, Fibroplasia retrolenticular, Retinopatia de prematuridade, Fibroplasia Retrolenticular, Retinopatia da Prematuridade
Italian Retinopatia da prematurità, Fibroplasia retrolenticolare, Fibroplasia retrolentale, Retinopatia dei prematuri
Dutch retrolentale fibroplasie, fibroplasie; retrolentaal, prematuriteit; retinopathie, retinopathie; prematuriteit, Retinopathie bij praematuritas, prematuren retinopathie, Fibroplasie, retrolentale, Retinopathie bij prraematuritas, Retrolentale fibroplasie
French Fibroplasie rétrocristalline, Rétinopathie des prématurés, Rétinopathie du prématuré, FIBROPLASIE RETRO-LENTALE, Fibroplasie rétrocristallinienne, Fibroplasie rétrolentale, Rétinopathie de la prématurité, Fibroplasie rétrolentale des prématurés
German retrolentale Fibroplasie, FIBROPLASIE RETROLENTAL, Netzhauterkrankung bei Fruehgeburt, Retinopathia praematurorum, Retrolentale Fibroplasie
Spanish Fibroplasia retrolenticular, fibroplasia retrolenticular (trastorno), fibroplasia retrolenticular, Retinopatía del Prematuro, Retinopatía de la Premadurez, Retinopatía del prematuro, retinopatía de los prematuros, síndrome de Terry, fibroplasia retrolental, retinopatía de la prematurez (trastorno), retinopatía de la prematurez, Fibroplasia Retrolenticular, Retinopatía de la Prematuridad
Swedish Retinopati hos prematura
Japanese ミジュクジモウマクショウ, スイショウタイゴセンイゾウショク, スイショウタイコウセンイゾウショク, 後水晶体線維形成, 未熟児網膜症, 後水晶体線形成症, 後水晶体線維増殖症, 後水晶体線維形成症, 水晶体後線維増殖, 水晶体後線維増殖症, 水晶体後部線維増殖, 水晶体後部線維増殖症
Czech retinopatie nedonošených, Retrolentální fibroplazie, Retinopatie nedonošených
Finnish Keskosen retinopatia
Korean 미숙 망막병증
Polish Zwłóknienie pozasoczewkowe, Rozrost włóknisty pozasoczewkowy, Retinopatia wcześniactwa, Retinopatia wcześniaków
Hungarian Koraszülöttek retinopathiája, Retrolentalis fibroplasia
Norwegian Retinopati hos premature, Fibroplasia retrolentalis, Retrolental fibroplasi