Retinopathy of Prematurity

What is Retinopathy of Prematurity (ROP)?

The retina is the lining of the back of the eye, where images are formed and sent to the brain. Retinopathy of Prematurity (ROP) happens when the retina’s blood vessels grow abnormally. The smaller a baby is at birth, the more likely that baby is to develop ROP, although there are many factors that determine if a baby will develop ROP.

How serious the ROP is depends on what part of the eye is affected (the zone); how far the disease has progressed (the stage); and whether the blood vessels are enlarged and twisted (plus disease)

Zones of the Eye

Zone 1 — near the center of the retina; core vision
Zone 2 — the middle of the retina
Zone 3 — the outer portions of the retina; peripheral vision

Stages of ROP

Stage I — Mildly abnormal blood vessels. Usually requires no treatment.

Stage II — Moderately abnormal blood vessels. Usually requires no treatment.

Stage III — Severely abnormal blood vessels. The blood vessels grow toward the center of the eye instead of following their normal growth pattern along the surface of the retina. Treatment is usually necessary and has a good chance of preventing retinal detachment.

Stage IV — Partially detached retina. Scar tissue from the abnormal vessels pulls the retina away from the wall of the eye. Treatment is necessary.

Stage V — Completely detached retina. Treatment is necessary.

 

“Plus Disease” means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease. When Plus Disease is present (any zone or stage), treatment is usually necessary. Pre-Plus Disease means that the eyes are showing warning signs of developing Plus Disease.

 

What Are the Treatment Options for Retinopathy of Prematurity (ROP)?

Avastin Therapy: Avastin is often used with cancer patients, but the drug works differently than chemotherapy. Avastin is a tumor-starving (anti-angiogenic) therapy that prevents the growth of blood vessels.

The drug targets and destroys the enlarged and twisted vessels (the Plus Disease) and allow healthy blood vessels to grow.
Avastin injections are administered bedside in the NICU. The procedure takes one minute and parents should be encouraged to Kangaroo Care their infants immediately afterwards to offer comfort.

Laser therapy “burns away” the periphery of the retina. Another less commonly used treatment option is cryotherapy, where the periphery of the retina is frozen. Both treatments are considered invasive surgeries on the eye. These treatments can slow or reverse the abnormal growth of blood vessels. Unfortunately, the treatments also destroy some side vision. Treatment is done to save the most important part of the sight – the sharp, central vision that is needed for “straight ahead” activities like reading and driving.

In the later stages of ROP, other treatment options include:

  • Scleral buckle. This involves placing a silicone band around the eye and tightening it. This prevents pulling on the scar tissue and allows the retina to flatten back down onto the wall of the eye. Sclera buckles are usually performed on infants with stage IV or V ROP.
  • Vitrectomy. Vitrectomy involves removing the the gel-like substance of the eye called the vitreous and replacing it with a saline solution. After the vitreous has been removed, the scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall. Vitrectomy is performed only at stage V.

Can ROP Cause Other Eye Problems?

Infants with ROP have a higher risk for developing eye problems later in life, such as retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma. In many cases, these eye problems can be treated or controlled.

This article is not a substitute for medical information. Please talk with your pediatric ophthalmologist for information specific to your preemie.