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TAS Opthalmology > Prematurity And The Eye ✅ > Flashcards

Prematurity And The Eye ✅ Flashcards

1
Q

When does vascularisation of the retina begin?

A

Around 14 weeks gestation

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2
Q

When is vascularisation of the retina complete?

A

Term

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3
Q

What stimulates vascularisation of the retina?

A

Vascular endothelial growth factor (VEGF-A) and insulin like growth factor (IGF-1), which work synergistically

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4
Q

What induces VEGF production?

A

Physiological fetal retinal hypoxia

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5
Q

Is IGF-1 production oxygen dependant?

A

No, it is oxygen independent

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6
Q

What do rising levels of IGF-1 stimulate?

A

Retinal angiogenesis during the second and third trimester

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7
Q

What is retinopathy of prematurity?

A

A neovascular disorder

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8
Q

Who does retinopathy of prematurity affect?

A

Infants born at less than 32 weeks gestational age

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9
Q

What are important additional risk factors for retinopathy of prematurity?

A
  • Extremely low birth weight (<1000g)
  • Early supplemental oxygen requirements
  • Acidosis
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10
Q

What % of babies born <1000g will develop ROP?

A

50%

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11
Q

What percent of babies born under 1000g will reach the threshold for treatment of ROP?

A

15%

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12
Q

Who should be screened for ROP?

A

All babies born under 32 weeks completed gestation and less than 1500g

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13
Q

What are the phases of development of ROP?

A
  1. Hyperoxic phase

2. Hypoxia phase

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14
Q

What happens in the hyperoxic phase in ROP?

A

Delivery into a high oxygen environment causes down regulation of VEGF, halting the normal progression of vascular tissue into the developing anterior retina

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15
Q

What happens in the hypoxic phase of ROP?

A

The unvasclarised anterior retina becomes increasingly ischaemic as it matures, VEGF is up regulated and leads to neovasularisation from the ridge of mesenchymal spindle cells at the anterior border of the vascularised retina

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16
Q

What happens in the hypoxic phase of ROP if left untreated?

A

The abnormal new vascular network creates a tractional retinal detachment and blindness

17
Q

What does the international classification of ROP classify on the basis of?

A
  • Stages of ROP development

- Zones of location in the retina

18
Q

What is stage 1 of ROP?

A

Demarcation line at anterior edge of vascularised retina

19
Q

What is stage 2 of ROP?

A

The line becomes thickened edge

20
Q

What is stage 3 of ROP?

A

The ridge develops neovascularisation

21
Q

What is stage 4 of ROP?

A

Localised tractional retinal detachment

22
Q

What is stage 5 of ROP?

A

Funnel retinal detachment

23
Q

What is plus disease in the classification of ROP?

A

Dilatation and tortuosityof the retinal vessels

24
Q

What are the zones of ROP?

A

Need a pic, but basically zone 1 includes disc and fovea, then expands out to zone 3

25
Q

What is aggressive posterior ROP?

A

Zone 1 disease, neovascularisation is not localised to the ridge

26
Q

What are the most aggressive forms of ROP?

A

Zone 1 and posterior zone 2

27
Q

What is the treatment threshold for ROP based on?

A
  • The zone of the disease
  • Disease stage
  • Presence of retina vascular dilatation and tortuisity (plus disease)
28
Q

What is the importance treatment of timely in ROP?

A

It can prevent progression to retinal detachment and blindness

29
Q

What has recently been discovered to correlate with the development of ROP?

A

A drop off in postnatal weight gain

30
Q

What does a drop off in postnatal weight gain mirror?

A

A fall in IGF-1 levels

31
Q

What is the clinical relevance of the development of ROP being correlated to a drop off in postnatal weight gain?

A

A computer based algorithm based on postnatal weight gain is being developed, which may help future identification of babies most at risk

32
Q

What is currently the preferred treatment for severe ROP?

A

Laser ablation of the avascular, ischaemic anterior retina

33
Q

What is a promising new treatment for severe ROP?

A

Intra-vitreal injection of an anti-VEGF agent

34
Q

Give 2 example of anti-VEGF agents

A

Bevacizumab

Ranibizumab

35
Q

What is the advantage of anti-VEGF treatment over laser in ROP?

A

Easier and quicker to perform

36
Q

What is the disadvantage of anti-VEGF treatment over laser in ROP?

A

Systemic absorption depresses serum VEGF levels for several weeks which may have systemic consequences, and the resultant prolonged absence of VEGF in the eye also delays the normal vascularisation of the anterior retina

37
Q

What is the result of the delayed vascularisation of the anterior retina with anti-VEGF agents?

A

It is non-perfused and ischaemic tor months beyond term

38
Q

What is anti-VEGF treatment reserved for in the UK?

A

The most severe cases, where laser therapy is not possible or sufficiently effective

TAS Opthalmology (9 decks)

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