Be Aware of Retinopathy of Prematurity in Premature Babies

Premature babies born early and with low birth weight are born before the development of the retinal blood vessels is complete. Vascular development continues after birth, but abnormal blood vessels may form; these vessels can pull on the retina, leading to detachment and, ultimately, retinopathy of prematurity, which can cause permanent vision loss.

Which babies are at risk?

Retinopathy of prematurity is one of the most significant issues for premature babies and can cause permanent blindness. Low birth weight, gestational age at birth, and the dose and duration of oxygen therapy are among the most important risk factors for the development of retinopathy of prematurity. Other risk factors include anemia, frequent and rapid blood transfusions, respiratory problems, systemic infections, underdeveloped lungs, a hole in the heart, genetic predisposition, and systemic corticosteroid use. Infants who are at risk—specifically those born prematurely and with low birth weight—must be monitored for retinopathy of prematurity. All infants born before the 35th week of gestation and weighing less than 2,000 grams are at risk and should be monitored until retinal vascularization is complete. Retinopathy of prematurity most commonly appears between the 6th and 8th weeks after birth. Therefore, the first examination should be performed by the 4th week after birth or at 31–32 weeks’ gestational age. Until retinal vascularization is complete, fundus examinations should be repeated every 1–2 weeks depending on the stage of the retinopathy.

How is ROP treated?

There are five stages of the disease. Stages 1 and 2 may resolve on their own. These infants should be monitored until retinal vascularization is complete, typically until the expected gestational age at birth. Starting from Stage 3, treatment with laser therapy or intravitreal anti-VEGF injections is required. If left untreated, the disease progresses to Stages 4–5, causing irreversible damage to the retina. Even if surgical treatment is performed at these stages, success rates are low.

Could babies with ROP develop eye problems later in life?

Eye problems develop in 55% of babies whose ROP has resolved. An eye examination performed during the first month of a newborn’s life enables the early diagnosis and treatment not only of retinopathy but also of many other eye conditions. Additionally, since these premature infants are at higher risk for eye conditions such as refractive errors, myopia, strabismus, cataracts, glaucoma, and amblyopia, follow-up examinations at ages 1 and 2 should also be conducted.

There has been an increase in retinopathy of prematurity in recent years

Along with this increase in retinopathy of prematurity in recent years, the primary reason is that while premature babies weighing less than 1,500 grams and born before 28 weeks could not be kept alive in the past, today even babies well below these thresholds can be kept alive in neonatal intensive care units equipped with advanced technology. Additionally, as in the rest of the world, the number of in vitro fertilization (IVF) centers has increased in our country in recent years, leading to a rise in the rates of multiple pregnancies and premature births. It is well-known that this situation contributes to an increase in high-risk pregnancies and, consequently, in the number of premature births.

References:

• American Academy of Pediatrics., American Academy of Ophthalmology., & American Association for Pediatric Ophthalmology and Strabismus. (2018, güncelleme 2022). Screening Examination of Premature Infants for Retinopathy of Prematurity.

• American Academy of Ophthalmology. (Güncel). Retinopathy of Prematurity – Preferred Practice Pattern.

• World Health Organization. (2014). Retinopathy of Prematurity: Report of a Joint WHO–IAPB Meeting.

• International Agency for the Prevention of Blindness. (Güncel). ROP Guidelines and Global Data.

• Turkish Ophthalmology Association. (Updated). Guidelines for the Diagnosis and Treatment of Retinopathy of Prematurity.

• Turkish Neonatology Association. (Updated). Guidelines for the Follow-up of Preterm Infants and ROP Screening.