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RETINOPATHY OF PREMATURITY

Chikita Artia Sari / I 11109014


Definition

Retinopathy of prematurity (ROP) is a disease


that primariy o!!urs in premature "a"ies#

It !auses a"norma "ood $esses to %ro& in the


retina' the ayer of ner$e tissue in the eye that
ena"es us to see# (his %ro&th !an !ause the
retina to deta!h from the "a!k of the eye' eadin%
to "indness#
Definition

ROP ori%inay !aed retroenta fi"ropasia' &as the


eadin% !ause of "indness in !hidren in the 1940s
and 19)0s#

ROP o!!urs &hen a"norma "ood $esses %ro&


and spread throu%hout the retina' the tissue that
ines the "a!k of the eye# (hese a"norma "ood
$esses are fra%ie and !an eak' s!arrin% the retina
and puin% it out of position# (his !auses a retina
deta!hment# Retina deta!hment is the main !ause
of $isua impairment and "indness in ROP#
Epidemiology

Reated to %estationa a%e (+A) and "irth &ei%ht ("&)#

ROP rare in "& , -000 %rams#

.0/ ROP in "& 0 1-)0% and ./ de$eop threshod ROP#

(hereshod ROP $ery rare in "& , 1-)0%#

9)/ ROP "e%ins at 1-214 &eeks +A#

(hreshod disease at 13 &eeks#

Re%ression &ith spontaneous heain% at 4)244 &eeks +A#

5on% term ophthami! foo& up of formery premature


neonates &ho suffered se$ere ROP#
Risk Factos

Prematurity (most si%nifi!ant)

567

Assisted $entiation on%er than one &eek

Surfa!tant therapy

8i%h "ood transfusion $oume

Sepsis

I98

6ron!hopumonary dyspasia

:e$ated arteria o;y%en tension


Pat!op!ysiology

Sta%e I< an initia in=ury (su!h as hypotension' hypo;ia' or


hypero;ia) !auses $aso!onstri!tion and redu!ed "ood fo&
to the retina' disruptin% the norma pro!ess of
$as!uari>ation#

Sta%e II< 9esses then either resume norma %ro&th or ne&


$esses %ro& a"normay out from the retina into the
$itreous# (he a"norma $esses ha$e in!reased
permea"iity &hi!h !an resut in edema and hemorrha%e#
Infammation ? fi"rous tissue ? tra!tion on the retina and
deta!hment# Aternati$ey' the a"norma $as!uari>ation
may re%ress &ith itte residua effe!t#
Pat!op!ysiology

Re!enty' the intera!tion "et&een insuin2ike


%ro&th fa!tor21 (I+@21) and 9:+@ has "een
studied and proposed to pay a roe in the
patho%enesis of ROP
Pat!op!ysiology
Diagnosis
@our features are e$auated<

Aone (121)

Sta%e (12))

:;tent

Presen!e or a"sen!e of pus disease

Aone 1' any sta%e ROP &ith pus disease#

Aone -' sta%e 1 &ith or &ithout pus disease#

Aone -' sta%e -/1 &ith pus disease#

Sta%e I
Bidy a"norma "ood
$esse %ro&th# Bany
!hidren &ho de$eop
sta%e I impro$e &ith no
treatment and e$entuay
de$eop norma $ision#
(he disease reso$es on
its o&n &ithout further
pro%ression#

Sta%e II
Boderatey a"norma
"ood $esse %ro&th#
Bany !hidren &ho
de$eop sta%e II impro$e
&ith no treatment and
e$entuay de$eop
norma $ision# (he
disease reso$es on its
o&n &ithout further
pro%ression#

Sta%e III
Se$erey a"norma "ood $esse
%ro&th# (he a"norma "ood
$esses %ro& to&ard the !enter of
the eye instead of foo&in% their
norma %ro&th pattern aon% the
surfa!e of the retina# Some
infants &ho de$eop sta%e III
impro$e &ith no treatment and
e$entuay de$eop norma $ision#

Sta%e I9
Partiay deta!hed retina#
(ra!tion from the s!ar
produ!ed "y "eedin%'
a"norma $esses pus the
retina a&ay from the &a of
the eye#
o
Sta%e 4A< e;!udes the
ma!ua
o
Sta%e 46< in!udes the
ma!ua

Sta%e 9
Competey
deta!hed retina and
the end sta%e of the
disease# If the eye
is eft aone at this
sta%e' the "a"y !an
ha$e se$ere $isua
impairment and
e$en "indness#
"Pus diseaseC

Presen!e indi!ates se$ere


ROP and is often foo&ed
"y rapid pro%ression

to retina deta!hment# Bay


"e a!!ompanied "y
$itreous ha>e'
en%or%ement

of the iris $esses' and poor


diation of the pupi#
Management

:(ROP D Cryo2ROP
(reat threshod disease as it de!reases
unfa$oura"e out!ome from 1) to 9/#
A"ation is "enefi!ia for prethreshod ROP#

Photo%raph s!reenin% for ROP


(eemedi!ine &ith on2site treatment#
Management

:$iden!e "ased s!reenin% !riteria


S!reen at 11 &eeks +A or 4 &eeks !hronoo%i!
a%e if "orn "efore -. &eeks#
Continue s!reenin% ti 4) &eeks +A or
$as!uarisation in >one 1#
S!reenin% of 1-)0%21400% infants is !ost effe!ti$e#
:(ROP < Re!o%ni>e prethreshod disease and
foo& up - &eeky#
@oo& up &eeky if >one -' sta%e - ROP
or if $as!uarisation ends in >one 1#
Management

(reatment of ROP
Porta"e indire!t aser units# 5aser superior to !ryotherapy#

ROP reated retina deta!hment


E mis!on!eptions
1# Sta%e 4A F "eni%n and !an &ait ti sta%e 46 "efore treatin%#
-# Poor pro%nosis &ith tota deta!hment#

Sur%ery reser$ed for sta%es 4A' 46 and )#
Intra$itrea triam!inoone in Sta%e ) reatta!hment su!!ess rate#
9ision restoration te!hnoo%y G future#
(8AHI JOK