Retinopathy of prematurity: Past, present and future

Abstract

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.

Asociación de la hemorragia prerretiniana con la presencia y la gravedad de la retinopatía del prematuro en pacientes de alto riesgo

“…En todo el mundo se reportan incidencias que van del 12 al 78%, en cualquiera de sus estadios, en niños nacidos con menos de 1500 g de peso [2][3][4] . Dentro de los factores sistémicos asociados se encuentran la inmadurez vascular, el estado de hipoxia, la edad gestacional, el embarazo múltiple, la dificultad respiratoria, la apnea, la acidosis, la bradicardia, la anemia, la sepsis y las transfusiones 5,6 .…”

“…La técnica de exploración debe realizarse bajo dilatación pupilar farmacológica y oftalmoscopia indirecta con uso de lente de 28 dioptrías. Generalmente se utilizan soluciones oftálmicas para dilatar a base de ciclopentolato (0.5%) y fenilefrina (2.5%), las cuales se aplican cada 15 minutos durante tres veces 2,7 . La Academia Americana de Pediatría establece que los infantes con peso al nacer de 1500 g o edad gestacional menor de 30 semanas de gestación, y ciertos casos particulares con peso al nacer de 1500-2000 g o edad gestacional mayor de 30 semanas de gestación con un estado clínico inestable, deben ser evaluados en búsqueda de ROP.…”

Hyperoxia and the Immature Brain

“…A large number of studies have confirmed the role of hyperoxia in the pathogenesis of prematurity-related diseases such as ROP and bronchopulmonary dys- 314 plasia (BPD) [42,54] . The clinical and experimental insights of the past decade have investigated how premature exposure to large amounts of oxygen in the neonatal period may disrupt brain maturation.…”

Exogenous erythropoietin aggravates retinal neovascularizationin a murine model of proliferative retinopathy

“…In ROP, retinal neovascularization (RNV) plays a central role and may lead to blindness (1,3). The first phase of ROP is mainly characterized by delayed vascular growth, and the second phase is mainly present as RNV (4,5).…”

“…Retinopathy of prematurity (ROP) is a blinding eye disorder that affects premature babies (1,2). In ROP, retinal neovascularization (RNV) plays a central role and may lead to blindness (1,3).…”