Engorgement

and tortuosity of the blood vessels near the optic nerve.

Also includes growth and dilation of abnormal blood vessels on the surface of the iris, rigidity of the iris, and vitreous haze (exudate along the retinal vessels).

Can accompany any stage, but indicates greater likelihood of progression to Stage 3 (or greater).

It is characterized by abnormal dilatation and tortuosity that is insufficient to be designated as plus disease

Increased likelihood of progression to retinal detachment if left untreated:

Zone I any stage Zone II Plus disease with stage 1, 2

It is defined as five contiguous or eight cumulative clock hours of extraretinal neovascularization (stage 3 disease) in zone 1 or zone 2, associated with plus disease, and is an indication for treatment.

Plus disease + Zone I ROP uncommon, if untreated, progresses to stage 5 does not usually progress through the classical stages 13 Progression from Stage 1 to Rush disease can occur within days

Prevent preterm labor. (Optimal) minimum use of oxygen. Prevention of complications.

 i.

Universal criteria for screening : Infants with birth wt < 1500g or GA < 31 weeks.

ii.
iii.

First examination 4/52 after birth.

Examination 1 or 2 weekly depending on stage of disease at initial visit.

iv.
v.

Treatment of threshold disease.

Examination until 45 weeks GA without threshold disease or till vascularisation reaches zone 3.

of avascular immature retina is recommended in infants with threshold disease .It is preferred over cryotherapy. Usually 600-1000 spots of laser as compared to 30-50 spots of cryotherapy needed

 Laser

is a direct treatment of the retina and its underlying tissue instead of the entire thickness of the eye wall like in cryotherapy.

Complications include: Anterior Segment Ischemia Cataracts Burns to Cornea, Iris

For threshold ROP (stage 3 in at least 5 clock hours with plus disease) Freezing the sclera with cold probe.

Multiple applications are done to the entire avascular area anterior to the neovascular ridge.

Bevacizumab has been introduced in many centres for the treatment of ROP. Limitations -optimal timing, frequency, and dose are yet to be established. The potential for systemic complications and long-term effects is also undefined in this age group

For shallow RD

For tractional RD not involving the macula (stage 4a) can be performed successfully with respect to anatomical and visual outcome. The visual outcome in stages 4b and 5, in which the macula is involved, is often disappointing despite successful reattachment.

In about 80% of cases ROP regresses spontaneously by a process of involution, or by evolution from a vasoproliferative to fibrotic phase leaving few residua. Spontaneous regression may even occur in eyes with partial retinal detachments.

Associated Features
Plus disease Pre-plus disease Threshold disease

Management
Prevention Laser

Aggressive posterior

(rush disease)

Photocoagulation Cryotherapy Intravitreal VEGF Scleral Buckle Lens Sparing Vitrectomy