Retinopathy of Prematurity: Current Understanding and Treatment

Hee Yoon Cho

doi:10.7599/hmr.2009.29.4.362

Journal List > Hanyang Med Rev > v.29(4) > 1044034

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho: Retinopathy of Prematurity: Current Understanding and Treatment

Review Article

Hanyang Medical Reviews 2009; 29(4): 362-369.

Published online: 30 November 2009

DOI: https://doi.org/10.7599/hmr.2009.29.4.362

Retinopathy of Prematurity: Current Understanding and Treatment

Hee Yoon Cho, M.D.

Department of Ophthalmology, School of Medicine, Hanyang University, Guri, Korea.

Corresponding author (hycho@hanyang.ac.kr)

Received 16 September 2009 Accepted 3 October 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Retinopathy of prematury (ROP) is a major cause of blindness that affects premature infants. With advances in neonatology, ROP is likely to emerge as a more significant problem of vision loss in children in developing countries. With the recent advances in basic science research, our understanding of the pathophysiology of ROP has rapidly evolved. Clinical trials along with natural history of the disease have lead to updated screening and treatment guidelines. For successful control of ROP, timely and accurate screening is very important because early treatment leads to favorable outcomes. New treatment modalities are being explored with pharmacologic agents targeting the modulation of angiogenesis. The improved surgical intervention offers the potential for preservation of vision for eyes of ROP-related retinal detachment. The body of information germane to caring for ROP from infancy to adulthood continues to grow up. Improved surveillance and treatment programmes are likely to be most effective in reducing blindness caused by ROP in developing countries.

Keywords: Retinopathy of prematurity, Screening, Vascular endothelial growth factor

Figures and Tables

Fig. 1

Retinal finding after laser photocoagulation in threshold ROP with plus disease and extensive extraretinal fibrovascular proliferation (EFP, white asterix). There are moderately intense, gray-white laser burns spacing of less than or equal to one-half burn widths on peripheral avascular retina. (quoted from: Kim JH, Yu YS. Assessment of retinopathy of prematurity (ROP) revised. Korean J Pediatr 2009:52:22-7).

Table 1

Timing of first eye examination based on gestational age at birth

Shown is a schedule for detecting prethreshold ROP with 99% confidence, usually before any required treatment.

^*This guideline should be considered tentative rather than evidence-based for infants with a gestational age of 22 to 23 weeks because of the small number of survivors in these gestational age categories.

^†If necessary

Table 2

Recommended schedule of follow-up examination on the basis of retinal findings classified according to the international classification

References

1. Terry TL. Retrolental fibroplasia in the premature infant: V. Further studies on fibroplastic overgrowth of the persistent tunica vasculosa lentis. Trans Am Ophthalmol Soc. 1944; 42:383–396.

2. Patz A, Eastham A, Higginbotham DH, Kehl T. Oxygen studies in retrolental fibroplasias II. The production of microscopic changes of retrolental fibroplasias in experimental animals. Am J Ophthalmol. 1953; 36:1511–1522.

3. Wheatley CM, Dickinson JL, Mackey DA, Craig JE, Sale MM. Retinopathy of prematurity: recent advance in our understanding. Br J Ophthalmol. 2002; 86:696–700.

4. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB, Tung B. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Incidence and early course of retinopathy of prematurity. Ophthalmology. 1991; 98:1628–1640.

5. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity: One-year outcome-Structure and function. Arch Ophthalmol. 1990; 108:1408–1416.

6. Statistics Korea. Annual report on the vital statistics. 2007.

7. Han YJ. A Study on the Estimation of Low-birth weight. Korea: Korea institute for health and social affairs;2007.

8. Lutty GA, Chan-Ling T, Phelps DL, Adamis AP, Berns KI, Chan CK, Cole CH, D'Amore PA, Das A, Deng WT, Dobson V, Flynn JT, Friedlander M, Fulton A, Good WV, Grant MB, Hansen R, Hauswirth WW, Hardy RJ, Hinton DR, Hughes S, McLeod DS, Palmer EA, Patz A, Penn JS, Raisler BJ, Repka MX, Saint-Geniez M, Shaw LC, Shima DT, Smith BT, Smith LE, Tahija SG, Tasman W, Trese MT. Proceedings of the third international symposium on retinopathy of prematurity:An update on ROP from the lab to the nursery (November 2003, Anaheim, California). Mol Vis. 2006; 12:532–580.

9. Smith LE. Pathogenesis of retinopathy of prematurity. Semin Neonatol. 2003; 8:469–473.

10. Tasman W, Patz A, McNamara JA, Kaiser RS, Trese MT, Smith BT. Retinopathy of prematurity: The life of lifetime disease. Am J Ophthalmol. 2006; 141:167–174.

11. Campbell K. Intensive oxygen therapy as a possible cause of retrolental fibroplasia; A clinical approach. Med J Aust. 1951; 2:48–50.

12. Patz A, Hoeck LE, De La Cruz E. Studies on the effect of high oxygen administration in retrolental fibroplasia. I. Nursery observations. Am J Ophthalmol. 1952; 35:1248–1253.

13. Ashton N, Ward B, Serpell G. Role of oxygen in the genesis of retrolental fibroplasia; A preliminary report. Br J Ophthalmol. 1953; 37:513–520.

14. Kinsey VE, Arnold HJ, Kalina RE, Stern L, Stahlman M, Odell G, Driscoll JM Jr, Elliott JH, Payne J, Patz A. PaO2 levels and retrolental fibroplasia: A report of the cooperative study. Pediatrics. 1977; 60:655–668.

15. Lofqvist C, Andersson E, Sigurdsson J, Engström E, Hård AL, Niklasson A, Smith LE, Hellström A. Longitudinal postnatal weight and insulin-like growth factor I measurements in the prediction of retinopathy of prematurity. Arch Ophthalmol. 2006; 124:1711–1718.

16. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of Cryotherapy for Retinopathy of Prematurity, Preliminary results. Arch Ophthalmol. 1988; 106:471–479.

17. Report of a Joint working Party of the Royal College of Ophthalmologists and the British Association of Perinatal Medicine. Retinopathy of Prematurity, guidelines for screening and treatment. Early Hum Dev. 1996; 46:239–258.

18. Section on Ophthalmology American Academy of Pediatrics. American Academy of Ophthalmology. American Association for Pediatric Ophthalmology and Strabismus. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2006; 117:572–576.

19. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005; 123:991–999.

20. The International Committee for the Classification of the Late Stages of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. II. The classification of retinal detachment. Arch Ophthalmol. 1987; 105:906–912.

21. Nissenkorn J, Kremer I, Gilad E, Cohen S, Ben-Sira I. "Rush" type retinopathy of prematurity: report of three cases. Br J Ophthalmol. 1987; 71:559–562.

22. Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised Indications for the Treatment of Retinopathy of Prematurity: results of the Early Treatment for Retinopathy of Prematurity Randomized Trial. Arch Ophthalmol. 2003; 121:1684–1694.

23. Good WV. Early Treatment for Retinopathy of Prematurity Cooperative Group. The Early Treatment for Retinopathy Of Prematurity Study: structural findings at age 2 years. Br J Ophthalmol. 2006; 90:1378–1382.

24. Ng EY, Connolly BP, McNamara JA, Regillo CD, Vander JF, Tasman W. A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: Part 1. Visual function and structural outcome. Ophthalmology. 2002; 109:928–934.

25. Connolly BP, Ng EY, McNamara JA, Regillo CD, Vander JF, Tasman W. A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: Part 2. Refractive outcome. Ophthalmology. 2002; 109:936–941.

26. Pearce IA, Pennie FC, Gannon LM, Weindling AM, Clark DI. Three year visual outcome for treated stage 3 retinopathy of prematurity: cryotherapy versus laser. Br J Ophthalmol. 1998; 82:1254–1259.

27. Capone A Jr, Diaz-Rohena R, Sternberg P Jr, Mandell B, Lambert HM, Lopez PF. Diode-laser photocoagulation for zone 1 threshold retinopathy of prematurity. Am J Ophthalmol. 1993; 116:444–450.

28. Park DH, Cho YW. A Comparison of Cryotherapy Versus Transscleral Diode Laser Photocoagulation for the Treatment of Retinopathy of Prematurity. J Korean Ophthalmol Soc. 2003; 44:331–337.

29. Banach MJ, Ferrone PJ, Trese MT. A comparison of dense versus less dense diode laser photocoagulation patterns for threshold retinopathy of prematurity. Ophthalmology. 2000; 107:324–327.

30. Oh WH, Yu YS. Clinical Outcomes of Scleral Buckle Encircling for the Retinal Detachment of Retinopathy of Prematurity. J Korean Ophthalmol Soc. 2004; 45:790–796.

31. Capone A Jr, Trese MT. Lens-sparing vitreous surgery for tractional Stage 4A retinopathy of prematurity retinal detachments. Ophthalmology. 2001; 108:2068–2070.

32. Prenner JL, Capone A, Trese MT. Visual outcomes after lens-sparing vitrectomy for stage 4A retinopathy of prematurity. Ophthalmology. 2004; 111:2271–2273.

33. Yu YS, Kim SJ, Kim SY, Choung HK, Park GH, Heo JW. Lens-sparing vitrectomy for stage 4 and stage 5 retinopathy of prematurity. Korean J Ophthalmol. 2006; 20:113–117.

34. Gonzales CR, Boshra J, Schwartz S. 25-gauge pars plicata vitrectomy for stage 4 and 5 retinopathy of prematurity. Retina. 2006; 26:S42–S46.

35. Smith LE. Pathogenesis of retinopathy of prematurity. Semin Neonatol. 2003; 8:469–473.

36. McLeod DS, Brownstein R, Lutty GA. Vaso-obliteration in the canine model of oxygen-induced retinopathy. Invest Ophthalmol Vis Sci. 1996; 37:300–311.

37. Donahue ML, Phelps DL, Watkins RH, LoMonaco MB, Horowitz S. Retinal vascular endothelial growth factor (VEGF) mRNA expression is altered in relation to neovascularization in oxygen induced retinopathy. Curr Eye Res. 1996; 15:175–184.

38. Mantagos IS, Vanderveen DK, Smith LEH. Emerging treatment for retinopathy of prematurity. Semin Ophthalmol. 2009; 24:82–86.

39. Shah PK, Narendran V, Tawansy KA, Raghuram A, Narendran K. Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol. 2007; 55:75–76.

40. Kong L, Mintz-Hittner HA, Penland RL, Kretzer FL, Chévez-Barrios P. Intravitreous bevacizumab as anti-vascular endothelial growth factor therapy for retinopathy of prematurity : Amorphologic study. Arch Ophthalmol. 2008; 126:1161–1163.

41. Mintz-Hittner HA, Kuffel RR Jr. Intravitreal injection of bevacizumab (avastin) for treatment of stage 3 retinopathy of prematurity in zone I or posterior zone II. Retina. 2008; 28:831–838.

42. Nonobe NI, Kachi S, Kondo M, Takai Y, Takemoto K, Nakayama A, Hayakawa M, Terasaki H. Concentration of Vascular endothelial growth factor in aqueous humor of eyes with advanced retinopathy of prematurity defore and after intravitreal injection of bevacizumab. Retina. 2009; 29:579–585.

43. Smith LE, Shen W, Perruzzi C, Soker S, Kinose F, Xu X, Robinson G, Driver S, Bischoff J, Zhang B, Schaeffer JM, Senger DR. Regulation of vascular endothelial growth factor-dependent retinal neovascularization by insulin-like growth factor-1 receptor. Nat Med. 1999; 5:1390–1395.

44. Connor KM, SanGiovanni JP, Lofqvist C, Aderman CM, Chen J, Higuchi A, Hong S, Pravda EA, Majchrzak S, Carper D, Hellstrom A, Kang JX, Chew EY, Salem N Jr, Serhan CN, Smith LE. Increased dietary intake of omega-3-polyunsaturated fatty acids reduces pathologicalretinal angiogenesis. Nat Med. 2007; 07. 13:868–873.

45. Connor KM, SanGiovanni JP, Lofqvist C, Aderman CM, Chen J, Higuchi A, Hong S, Pravda EA, Majchrzak S, Carper D, Hellstrom A, Kang JX, Chew EY, Salem N Jr, Serhan CN, Smith LE. Increased dietary intake of ω-3-polyunsaturated fatty acides reduces pathological retinal angiogenesis. Nat Med. 2007; 13:868–873.

46. Crawford MA, Costeloe K, Ghebremeskel K, Phylactos A, Skirvin L, Stacey F. Are deficits of arachidonic and docosahexaenoic acids responsible for the neural and vascular complications of preterm babies? Am J Clin Nutr. 1997; 66:1032S–1041S.

47. Quinn GE, Dobson V, Repka MX, Reynolds J, Kivlin J, Davis B, Buckley E, Flynn JT, Palmer EA. The Cryotherapy for retinopathy of rematurity cooperative group. Development of myopia in infants with birth weights less than 1251 grams. Ophthalmology. 1992; 99:329–340.

48. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Effect of retinal ablative therapy for threshold retinopathy of prematurity: results of Goldmann perimetry at the age of 10 years. Arch Ophthalmol. 2001; 119:1120–1125.

49. Kim MJ, Kim SJ, Yu YS. The risk for retinal detachment associated with hemorrhages pre- and postlaser treatment in retinopathy of prematurity. Retina. 2008; 28:1451–1457.

50. Gilbert C, Foster A. Childhood blindness in the context of vision 2020-the right to sight. Bull World Health Organ. 2001; 79:227–232.

TOOLS

Similar articles