ROP
stage
1-demarcation
2-ridge
3-ridge and
NV
4-RD, a is
no foveal involvement, b is
5-f/u RD
plus disease
dilation of
the veins and tortuosity of the arteries in the post. pole
also see:
engorgement of iris vessels, pupillary rigidity, vitreous haze
other
findings:
shallow ac
corneal
edema
iris
atrophy, PS, entropion uvea
regressed
rop:
peripheral-
failure to
vascularize
telangiectatic
vessels
peripheral
folds
lattice-like
degeneration
rd
posterior:
arterial
tortuosity
dragging of
vessels
falciform
folds
dragging of
retina over disc
assoc
findings:
myopia -
increases in direct relation to severity
strabismus -
15% of infants, risk increases with more posterior zones
glaucoma -
active ROP, regressed ROP (inc in adulthood)
DDx
FEVR -
familiar exudative vitreoretinopathy, neovascularization may occur several yeas
after birth, usually happens later in life
Retinoblastoma
- rb in premature infant possible but rare, family hx, ultrasound, ct scan
PFV -
persistent fetal vasculature, aka PHPV - also gives leucocoria and detached
retina, usually unilateral
Norrie's dz
Risk factors
established:
prematurity, low birth weight, complex hospital course, prolonged supp O2
other
reported assocations: cyanosis, apnea, mech ventilation, intraventricular hemorrhage,
septicemia
ROP
screening
timing of
progression determined by postmenstrual age rather than time since birth:
median time
to:
stage 1 - 34
wks
stage 2 -
35.4 wks
threshold -
36.9 wks (90% b/w 34 and 42 wks)
crucial
window for screening is 32-42 wks
AAO and AAP
'97 - screen all infants <1500g or <28 wks gestation
ROP
screening
screening to
begin 4-6 wks from birth (31-33 wks postmenstrual age)
schedule for
f/u-
zone II, no
ROP, 2-4 wks
zone I, no
ROP, 1-2 wks
any ROP in
zone II, 1-2 wks
threshold
ROP, treat within 72 hrs
Cryo-ROP
study
cryo the
avascular retina
current
concepts:
laser used
instead of cryo
zone III,
rarely if ever treat
zone II,
cryo-rop criteria
zone I, ?,
has ETROP study
treatment:
rd: >13
sectors of RD, 92% unfavorable outcome
1-3 sectors
of RD - 50% LP or worse