Retinopathy of Prematurity Dr Soujanya K Assistant Professor

Specific learning objectives • To describing pathogenesis of ROP • To describe prevention and

What is ROP? • Retinopathy of prematurity (ROP) is a proliferative retinopathy affecting premature

Risk factors • Birth weight < 1500 gm • </= 32 wks GA •

A discrete line of demarcation separates avascular retina from vascular retina

Zone 1: Radius- twice the distance from the disc & fovea

Zone 2: Radius- centre of the disc to the nasal ora serrata

Screening • Prophylaxis: • Newborn – incubator O 2 saturation <30%

Who need screening? • All premature babies born at – less than or equal

When to screen? • First examination: – Between 6 and 7 weeks post-natal age

How to screen? • Dilated fundus examination with Indirect ophthalmoscopy with 28 D lens

Treatment • Indirect laser photocoagulation

• Retinitis pigmentosa is a hereditary disorder predominantly affecting the rods more than

Symptoms • Night blindness. • Tubular vision occurs in advanced cases.

Arteriolar Attenuation Waxy Disc Pallor. Retinal Bone-spicule Pigmentation

• Includes a rapid axial growth of the eyeball beyond normal variation.

Myopic crescent & Super-traction crescent

• Foster-Fuchs' spot: dark red circular patch due to sub-retinal neovas-cularization and choroidal

LACQUER CRACKS • spontaneous ruptures of the Bruch’s membrane that appear yellowish-white and are

Questions • When should a premature baby be screened to prevent retinopathy of prematurity?

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Retinopathy of Prematurity Dr Soujanya K Assistant Professor, Dept. of Ophthalmology, YMCH

Specific learning objectives • To describing pathogenesis of ROP • To describe prevention and screening protocol of ROP • To understand management of ROP • To describe clinical features of Retinitis pigmentosa • To describe clinical features of pathological myopia

What is prematurity?

What is ROP? • Retinopathy of prematurity (ROP) is a proliferative retinopathy affecting premature infants of very low birth weight, who have often been exposed to high ambient oxygen concentrations

Risk factors • Birth weight < 1500 gm • </= 32 wks GA • Exposure to high concentration of oxygen

Normal angiogenesis

4 months Temporal Retina Nasal Retina

8 months Temporal Retina Nasal Retina

10 months Temporal Retina Nasal Retina

PATHOGENESIS

Increased oxygen saturation

Obliteration of retinal vessels

Release of VEGF

Neovascularisation

Fibrous tissue proliferatio

Retinal detachment

Sub-Total Retinal detachment

Total Retinal detachment

Pseudoglioma

STAGES OF ROP

A discrete line of demarcation separates avascular retina from vascular retina

ZONES IN ROP

Zone 1: Radius- twice the distance from the disc & fovea

Zone 2: Radius- centre of the disc to the nasal ora serrata

Zone 3: Temporal crescent

Screening • Prophylaxis: • Newborn – incubator O 2 saturation <30%

Who need screening? • All premature babies born at – less than or equal to 32 weeks of gestational age – Weighing 1500 g or less

When to screen? • First examination: – Between 6 and 7 weeks post-natal age or – 34 weeks post-conceptual age (whichever is earlier). Eg: Baby born at 32 wks on 1/1/2018 After 6 wks : 15/02/2018 or When baby is 34 wks: 15/01/2018

How to screen? • Dilated fundus examination with Indirect ophthalmoscopy with 28 D lens

Tele-medicine

Treatment • Indirect laser photocoagulation

Treatment

Retinitis pigmentosa

• Retinitis pigmentosa is a hereditary disorder predominantly affecting the rods more than the cones.

What is the function of rods?

Symptoms • Night blindness. • Tubular vision occurs in advanced cases.

Arteriolar Attenuation Waxy Disc Pallor. Retinal Bone-spicule Pigmentation

Advanced Changes

End-stage Disease

FIELD OF VISION

Pathological myopia

• Includes a rapid axial growth of the eyeball beyond normal variation.

Myopic crescent

Myopic crescent & Super-traction crescent

• Foster-Fuchs' spot: dark red circular patch due to sub-retinal neovas-cularization and choroidal haemorrhage

Foster-Fuchs' spot

Foster Fuchs’ spot

Posterior staphyloma

Posterior vitreous detachment

Vitreous liquefaction

LACQUER CRACKS • spontaneous ruptures of the Bruch’s membrane that appear yellowish-white and are usually located in the posterior pole.

Peripheral retinal degeneration

Questions • When should a premature baby be screened to prevent retinopathy of prematurity? • What are the differential diagnosis of pseudoglioma? • What are the clinical features of retinitis pigmentosa? • Draw a neat labeled diagram depicting features of pathological myopia.