Retinopathy of Prematurity
Retinopathy of prematurity or also known as ROP Disease, is a disease of the retina of babies born with low body weight, due to deficiencies in their early postnatal development. It is an eye disease that occurs in the avascular areas in the layer and causes nerve damage, resulting in vision loss if left untreated.
In English “Retinopathy of Prematurity" The word "ROP" is also frequently used as its abbreviation.
The disease is one of the most common causes of childhood blindness, especially in developed countries. ROP can cause nerve damage, causing permanent vision loss.
SUBJECT TITLES
- What is Retinopathy of Prematurity? Why Does ROP Happen?
- How to Examine for Retinopathy of Prematurity? How is it diagnosed?
- When Should the First Examination Be Done in Babies?
- How Often Should ROP Examination Be Performed?
- Stages of Rop Disease and Classification of the Disease
- What Other Eye Problems Can Retinopathy of Prematurity Cause?
- Why Does Rope Disease Cause Blindness?
- How is Retinopathy of Prematurity Treated?
What is Retinopathy of Prematurity? Why Does ROP Happen?
Retinopathy of prematurity (ROP Disease) is a serious eye disease that occurs with abnormal vascular development on the avascular surfaces of the retina in babies born prematurely and with low birth weight (before 32 weeks and less than 1500 grams).
The development of the human eye can continue close to birth and even up to a month after birth. Premature babies are kept in incubators for a certain period of time after birth because they cannot fully develop due to premature birth. During this period, they are exposed to high levels of oxygen. As a result of this situation, babies born before the development of their eye vessels have completed may experience an abnormal development in their eye veins.
Exposure of prematurely born babies to high oxygen suddenly reduces the amount of VEGF, which provides vascular development. As the amount of VEGF decreases, narrowing and deterioration of the vessels occur. Thus, the nutrition of the retinal layer is interrupted.
In the immediate aftermath, the excessive increase in the amount of VEGF, abnormal vascularization and bleeding within the eye poses the risk of retinal detachment.
Retinopathy of prematurity< /strong> does not occur in term babies who receive phototherapy due to jaundice. Babies under high oxygen therapy in incubators born before 32 weeks and weighing less than 1500 grams constitute the risk group. Risk factors increase even more in babies with lung disease, brain hemorrhage and sepsis.
The disease is not detected by the baby's relatives. Because the disease does not cause any symptoms that can be noticed from the outside. Therefore, regular ophthalmologist check-ups and early treatment initiation are important in order to detect and treat the disease and prevent vision loss in premature babies.
Premature retinopathy consists of 5 stages. Dissociation occurs in stage 4, when the baby is 10 months old. The most critical stage for the beginning of treatment is the 3rd stage, just before the separation begins.
CLICK TO MAKE AN APPOINTMENT WITH OUR EYE DOCTORS
How to Examine for Retinopathy of Prematurity? How is it diagnosed?
Examination for retinopathy of prematurity begins with numbing the eye with drop anesthesia. It is then done by dilating the pupils with a different eye drop. After the pupils are dilated, the eyelids are opened in a way that does not cause any discomfort to the baby.
Each layer of the retina is examined separately for both eyes. Here, the development status of the vessels and the stage of the disease are examined.
When Should the First Examination Be Done in Babies?
Retinopathy of prematurity The first examination should be performed between the 4th and 6th weeks after birth in premature babies and babies weighing less than 1500 g, who are in the risk group for retinopathy of prematurity. In very premature births, the first examination can be waited until 8 weeks later. Additionally, ROP examination can be performed on premature babies in intensive care.
Since retinopathy of prematurity does not show any direct symptoms from the outside, sensitivity of the family is important for the first eye examination in premature births. Regular eye examinations are important for the timely diagnosis and success of the treatment for diseases such as eye pressure, amblyopia, and tear duct obstruction, as well as eye droop.
How Often Should ROP Examination Be Performed?
After the first examination, depending on the degree of progression of the disease, regular examinations are repeated at 1-2 week intervals until the baby is 46 weeks old. Especially in very premature babies, this period is a maximum of 1 week. Depending on the situation, they may need to have eye examinations every 3-4 days.
Stages of Rop Disease and Classification of the Disease
The areas used in the classification of the disease are as follows:
Zone 1: A circular area with a diameter twice the distance between the macula region and the optic disc, with the optic disc in the middle region. p>
Zone 2: Circular area with the optic disc in the center, encompassing the entire retina downwards
Zone 3: Outside zone 2 and crescent-shaped area towards the opposite direction of this area
The disease is considered in 5 different stages and these stages are as follows:
1st Stage: Abnormal and slight growth in blood vessels
2nd Stage: Moderately abnormal vascular growth.
The disease can resolve and regress on its own in this 2nd stage, or it can progress to the 3rd stage after this stage. may develop.
3rd Stage: Abnormal vascular growth in the retina at high speed.
4th Stage: Beginning of separation in the retina.
Stage 5: The last stage of the disease and the occurrence of retinal detachment.
What Other Eye Problems Can Retinopathy of Prematurity Cause?
Retinopathy of prematurity causes blindness in the most advanced stage. Blindness is the most undesirable consequence that occurs due to neglect, lack of follow-up and starting treatment too late. The disease largely regresses on its own. A smaller proportion of patients require treatment.
Since premature babies cannot recognize the symptoms that occur as a result of damage to the retina in the eye, the main responsibility here falls on their families.
If the disease has regressed on its own, this In babies, myopia, strabismus, lazy eye and eye pressure problems may develop. Additionally, these problems can be treated and regressed with early diagnosis.
Why Does Rope Disease Cause Blindness?
Due to premature birth, the development of the baby's vascular and tissue system in the retina is not fully completed. In the baby placed in an incubator after premature birth, VEGF is released due to a false alarm and vascularization occurs in the avascular areas of the retina. Retinal detachment occurs due to this vascularization and intraocular bleeding that occurs outside the natural process. As a result, permanent blindness occurs.
How is Retinopathy of Prematurity Treated?
Success in the treatment of the disease is directly related to the stage at which treatment is started. In the first two stages, the disease is usually monitored. Starting from the 3rd stage, laser or cryo treatment is applied.
Because the best response to treatment is given in the 3rd stage. If these treatments are inadequate, surgical intervention is necessary. The option at this point is vitrectomy surgery. Regular check-ups at the next stage are planned according to the stage of the disease.
Injection treatment: An attempt is made to prevent abnormal vascular growth by giving medication by injection into the eye.
Laser Treatment: It can be applied alone or with injection therapy. The aim of the treatment is to deactivate the cells that cause incorrect vascular formation in the vascular area of the retina.
Vitrectomy Surgery: If other treatments do not provide results, vitrectomy surgery is used. It is used in cases where there is a risk of permanent blindness in advanced stages of the disease.
