Retinopathy of prematurity

Overview & Definition

Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels in which the immature, incompletely vascularised retina grows abnormal new vessels that can scar, contract, and detach. It is the leading cause of preventable childhood blindness in high-income countries, and it is entirely a disease of prematurity: the more immature the infant, the greater the risk [7].

The crucial clinical point is that ROP is silent at the bedside. An infant can be growing, weaning from oxygen, and outwardly well while sight-threatening disease develops silently in the periphery of the retina. For this reason, ROP is not a diagnosis made from symptoms or vital signs. It is found only by scheduled retinal examination of infants who are at risk by virtue of gestational age and birth weight, and the entire purpose of a screening programme is to detect and treat the disease before it reaches the point of irreversible retinal detachment [6].

Classification is governed worldwide by the International Classification of Retinopathy of Prematurity, now in its third edition (ICROP-3), which standardises how every eye is described by three axes — zone, stage, and the presence of plus disease [1].

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1. [1]Chiang MF, Quinn GE, Fielder AR, et al International Classification of Retinopathy of Prematurity, Third Edition Ophthalmology, 2021.PMID 34247850
2. [2]International Committee for the Classification of Retinopathy of Prematurity The International Classification of Retinopathy of Prematurity revisited Arch Ophthalmol, 2005.PMID 16009843
3. [3]Cryotherapy for Retinopathy of Prematurity Cooperative Group Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results Pediatrics, 1988.PMID 2895910
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8. [8]Stoll BJ, Hansen NI, Bell EF, et al Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012 JAMA, 2015.PMID 26348753
9. [9]Finer NN, Carlo WA, Walsh MC, et al. Early CPAP versus surfactant in extremely preterm infants N Engl J Med, 2010.PMID 20472939
10. [10]Quinn GE, Ying GS, Daniel E, et al. Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity JAMA Ophthalmol, 2014.PMID 24970095
11. [11]Geloneck MM, Chuang AZ, Clark WL, et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial JAMA Ophthalmol, 2014.PMID 25103848