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Retinopathy of Prematurity

Eye Exam Indications
1. Infant birth weight <1300g (gestational age <30 weeks)
  1. Perform initial eye exam at 5 weeks of age
2. Infant birth weight <1800g (gestational age <36 weeks)
  1. And Received Supplemental Oxygen
  2. Perform initial eye exam at 5-8 weeks of age
3. Infant with prolonged Supplemental Oxygen exposure
Pathophysiology
1. Retinal vessels develop over a long period of time
  1. Onset at 22 weeks
  2. Starts from Optic Nerve and slowly vascularizes
2. Vessels are very reactive
  1. Increased oxygen exposure leads to vasoconstriction
    1. Results in tissue necrosis
    2. Retrolental fibroplasia
    3. Results in vessel proliferation
  2. Increased carbon dioxide leads to vasodilation
Risks
1. Very premature infants are at high risk
  1. Difficult to prevent retinopathy
  2. Retinopathy of prematurity occurs in 95% at 25 weeks
2. Risk is very low for older children (unless hyperoxia)
Anatomy
1. Zone 1
  1. Circumferential around Optic Nerve area
  2. Zone 1 changes are predictive of severe retinopathy
2. Zone 2
  1. Middle region
3. Zone 3
  1. Peripheral circumference on retina
Signs
1. Dilate eyes 30 minutes before exam
  1. Cyclomydril 1 drop each eye
  2. Apply drop twice, 5 minutes apart
2. Funduscopic Staging of Retinopathy
  1. Stage 1: Demarcation Line
  2. Stage 2: Ridge
  3. Stage 3: Extraretinal fibrovascular proliferation
  4. Stage 4: Retinal Detachment
Management
1. Prevent premature births
2. Prevent Hyperoxia
3. Eye exams every 1-2 weeks (assess for Stage 3)
4. Laser ablation (or Cryotherapy) indications
  1. Stage 3 retinopathy of prematurity
  2. Prevents vessel proliferation and progression
Prognosis
1. Infant >38 weeks (corrected) without retinopathy
  1. Will not develop retinopathy of prematurity
2. Future Risks

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.