Flashcards in Retinopathy of prematurity: An update on screening and management Deck (16):
What is ROP?
a proliferative disorder of the developing retinal blood vessels in preterm infants, may lead to poor visual acuity or blindness
What percentage of neonates born <31wks GA develop some stage of ROP?
What percentage of neonates born <31wks GA develop severe ROP?
What percentage of neonates born <31wks GA require ROP treatment?
What are the stages of ROP?
Stage 1 - demarcation line separating avascular from vascularized retina
Stage 2 - Ridge arising in region of demarcation line
Stage 3 - Extraretinal fibrovascular proliferation/neovascularization extending into the vitreous
Stage 4 - Partial retinal detachment
Stage 5 - Total retinal detachment
Plus disease - Increased vascular dilatation and tortuosity of posterior retinal vessels in at least two quadrants of the retina
Pre-plus disease - More vascular dilatation and tortuosity than normal but insufficient to make the diagnosis of plus disease
Type 1 ROP:
a) Zone I – any stage ROP with plus disease as well as stage 3 ROP without plus disease
b) Zone II – stage 2 or 3 ROP with plus disease
Type 2 ROP
a) Zone I – stage 1 or 2 ROP without plus disease
b) Zone II – stage 3 ROP without plus disease
What are the current indications for treatment of ROP (Type 1 ROP)?
1. Zone I – any stage ROP with plus disease
2. Zone I – stage 3 ROP without plus disease
3. Zone II – stage 2 or 3 ROP with plus disease
What is the recommendations regarding ROP screening in Canada?
1. All infants <31 weeks GA
2. Infants = 1250g
3. Infants believed to be at high risk for ROP
When should the first ROP screening examination occur?
At 31 weeks GA for infants 22-27 weeks GA
At 4 weeks chronological age for infants born at >28 weeks GA
What type of screening can be used in the community?
Digital retinal photography
What methods should be used for analgesia in pain control?
2. Topical anesthetics
What are indications for follow-up in >1 week?
1. Immature vascularization, zone 1 - no ROP
2.Immature retina extends into posterior zone II, near boundary of zone I
3. Stage 1 or 2 ROP, no plus disease, zone I
4. Stage 3 ROP, no plus disease, zone II
5. Presence or suspected presence of aggressive posterior ROP
6. Inability to determine zone due to hazy view
What are the indications for follow-up in 1-2 weeks?
1. Immature vascularization, posterior zone II
2. Stage 2 ROP, no plus disease, zone II
What are the indications for follow-up in 2 weeks?
1. Stage 1 ROP, no plus disease, zone II
2. Immature vascularization, zone II – no ROP
3. Unequivocally regressing ROP, zone II
What are indications for follow-up in 2-3 weeks?
1. Stage 1 or 2 ROP, no plus disease, zone III
2. Regressing ROP, zone III
What are the indications to stop screening?
1. Vascularization in zone III without previous zone I or II ROP
2. Full retinal vascularization in close proximity to the ora serrata for 360°
3. Postmenstrual age of 50 weeks and no prethreshold or worse ROP
4. Regression of ROP (no abnormal vascular tissue capable of reactivation and progression present in zone II or III)