Retinopathy of Prematurity (ROP)

Retinopathy of Prematurity (ROP)

  Autor Dr. Eugen Prajinariu Data: 23.02.2006

Retinopathy of Prematurity (ROP)

Retinopathy of the premature baby is a common disease of the retina especially in premature infants with low weight. It has been long considered one of the most feared complications of prematurity. Research in recent years and modern treatment and prevention techniques used have made great progress in this area, leading to a shortage of cases of blindness in premature babies.

In premature infants having less than 1800 grams at birth, or gestation age less than 30 weeks, 50% develop retinopathy. The risk increases as gestational age decreases, this it could reach 90% in those aged less than 28 weeks.

Factors that cause retinal lesions are associated: 

  • Less than 32 weeks gestational age, low weight (less than 1500 grams - premature of grade III and IV);
  • Deficiency of vitamins (especially vitamin E) existing in premature because vitamins and minerals assimilation by the fetus is in the last trimester of pregnancy;
  • Prolonged oxygen therapy and in excess concentrations;
  • Mechanical ventilation (breathing maintenance by apparatus) for a longer period of time;
  • Low oxygenation with the maintenance of a high level of blood carbon dioxide;
  • Other diseases occurring in premature in the form of complications or existing before birth: anemia, cardio-respiratory failure, shock, hemorrhage, seizures, hypothermia, congenital diseases;
  • Diseases of the mother during pregnancy: maternal diabetes, hypertension, smoking;

In preterm infants, the retina, like other tissues in the body is not matured. In short, the presence of risk factors lead to abnormal development of the retina which, in fact is not what it should be, but turns into a cluster of aberrant blood vessels that later become fibrous, lead to the formation of membranes in the eye and retinal detachment. The process evolves in five stages (the latter being retinal detachment), usually begins after about first two weeks of life and final irreversible injuries, is determined after 6 months. Because the degenerative process can occur in different areas of the retina, the prognosis and sequelae are different. Also, disease severity depends on how fast this degeneration begins and evolves. Thus, children may later present glaucoma, strabismus, myopia, amblyopia or total loss of sight. There are situations when glaucoma or retinal detachment may occur in adulthood, after 20-30 years.

To prevent this complication, it is primarily needed to prevent premature birth. Pregnant in risk will be made directly observed therapy by your family doctor and will carry out regular examinations at the obstetrician for choosing the appropriate treatment. When the baby is born before term, strict monitoring of vital signs begins, medications are fixed with great caution and the concentration of oxygen in the medical air administered to premature baby is changed according to the values shown on monitors and laboratory results. We must know that not only the oxygen excess and oxygen insufficiency cause retinopathy. Given the existing vitamins deficiency in premature, vitamin E can be taken, but it will be taken into account the severe adverse effects that can be given by this vitamin in premature infants, i.e., sepsis, ulcerative-necrotic enterocolitis, or cerebral hemorrhage.
Premature babies with retinopathy risk require ophthalmological examination at 3-4 weeks after birth and then regular checks every 2-3 weeks in order to highlight some possible damage to the retina since the early stages. One of the methods of treatment for retinopathy of premature baby (less used because of unwanted side effects) is cryotherapy (the destruction process by freezing the affected area of the retina). A method with fewer side effects than the first, used successfully in maternity centers of ophthalmology, is the laser. After surgery, the child will make ophthalmologic examinations regularly.



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