Retinopathy of prematurity.pdf ROP newborn

ROP

1. RETINOPATHY OF
PEMATURITY

2. Retinopathyofprematurity(ROP)is
amultifactorialvasoproliferative
retinaldisorderthatincreasesin
incidence with decreasing
gestationalage.
It’sadiseaseofdevelopingretinal
vasculature.

3. Itmaydevelopinpreterminfants
(lessthan37weekofgestational
age)duetoretinalimmaturityand
hyperoxiaresultingfromhigh
constructionofO2therapy.

4. 1.LBW < 2500gm, VLBW < 1250gm
2.GA <37 weeks
3.Excess oxygen therapy
4.RDS
5.Septicemia

5. 1.Abnormalbloodvesselgrowthintheretina
2.Rapidoruncoordinatedeyemovements
(nystagmus)
3.Leukocoriaortheappearanceofawhite
pupil.
4.Crossedeyesorstrabismus
5.Dilatedortortuousbloodvesselsinthe
retina.
6.Retinalhemorrhagesorbleedingwithinthe
retina.

6. Due to complication (prematurity or hyperoxygenation)
Poor vascularisation and myelination
Cessation of vasculogenesis
Hyperoxiacauses vasoconstriction of retinal arteries
Retinal hypoxia and retinal edema
Formation of demarcation line between vascularised and
avascularised retina
Retinal hemorrhageleads to retinal detachment

7. Stage1:MildROP
Inthisearlystage,thereismildabnormal
vesselgrowth.Thebloodvesselsmayappear
dilated.
Stage2:ModerateROP
Theabnormalvesselgrowthprogressestoa
moderatelevel.Thevesselsmaybecomemore
tortuous,andtheriskofcomplications
increases.
Stage3:SevereROP
Atthisstage,theabnormalbloodvesselsgrow
intothevitreousgelinthecenteroftheeye.

8. Stage4:Partialretinaldetachment
InStage4,thereisapartialdetachmentof
theretinaduetothetractioncreatedbythe
abnormalbloodvessels.
Stage5:Totalretinaldetachment
Thisisthemostadvancedandseverestage
ofROP.Totalretinaldetachmentoccurswhen
theabnormalbloodvesselscausetheretina
todetachcompletely.Stage5ROPposesa
highriskofpermanentvisionlossifnot
treatedpromptly.

9. Ophthalmoscoy-ROPcanbediagnosedby
examinationwithophthalmoscope.
Dilationofpupilwith1dropof
Tropicamide(0.5%)10-15minutes4
times.
Afterdilatingtheinfant’spupilsretinais
examinedwithasmallhandhelddevice
(ophthalmoscope).

11. 1.IdentifynewbornsatriskofROPat
admissiontotheNICU.
2.Monitoroxygensaturationsinallbabies
onoxygenandsettargetsbetween90to
95%.
3.Restrictusageanddurationof
antibiotics,intravenous fluids,
parenteralnutrition.
4.Encouragemothersofpretermbabiesto
usekangaroomothercare,continue
withbreastfeeding.

12. 5.Co-ordinatewiththeneonataland
ophthalmology team intimely
preparationofthenewbornforROP
screening.
6.Atdischargebriefthemotheronthe
needforsubsequentscreeningforROP.

13. 1.Lasertherapyorphotocoagulation-During
theprocedure,alaserisusedtocreatesmall
burnsorscarsontheperipheralareasofthe
retinatopreventretinaldetachment.
2.Scleralbuckling-Itisasurgicalprocedure
usedtorepairretinaldetachmentinROP.It
aimstosupporttheretinaandcloseretinal
breaksortears,preventingfurther
detachment
3.ROPcanbepreventedbypreventionof
pretermdeliveryandappropriateuseofO2
therapy.