Retinopathy of prematurity (ROP)

H35.1

DESCRIPTION

ROP is a potentially preventable cause of blindness.

ROP is classified into five stages, ranging from mild (stage I) to severe (stage V):

Stage I – Mildly abnormal blood vessel growth.

  • Many children who develop stage I improve with no treatment and eventually develop normal vision.
  • The disease resolves on its own without further progression.

Stage II – Moderately abnormal blood vessel growth.

  • Many children who develop stage II improve with no treatment and eventually develop normal vision.
  • The disease resolves on its own without further progression.

Stage III – Severely abnormal blood vessel growth.

  • The abnormal blood vessels grow toward the centre of the eye instead of following their normal growth pattern along the surface of the retina.
  • Some infants who develop stage III improve with no treatment and eventually develop normal vision.
  • However, when infants have a certain degree of Stage III and "plus disease" develops, treatment is considered.
  • "Plus disease" means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease.
  • Treatment at this point has a good chance of preventing retinal detachment.

Stage IV – Partially detached retina.

  • Traction from the scar produced by bleeding, abnormal vessels pulls the retina away from the wall of the eye.

Stage V – Completely detached retina and the end stage of the disease.

  • If the eye is left alone at this stage, the baby can have severe visual impairment and even blindness.

TIMING OF SCREENING

  • Screening should be done at: 4-6 weeks chronological age or 31-33 weeks post conceptional age (whichever comes later).

MEDICINE TREATMENT

Dilation of the pupils for ROP screening by ophthalmologist:

  • Cyclopentolate 0.5%/phenylephrine 2.5%, ophthalmic drops, instil one drop every five minutes for three doses one hour before examination.

REFERRAL

  • All neonates weighing less than 1 250 g OR ≤30 weeks gestational age OR those 1250g - 1500g with high risk for ROP (on prolonged oxygen) should be screened for ROP by ophthalmological examination.