RETINOPATHY OF PREMATURITY
Which grade of ROP (Retinopathy of Prematurity) shows a ridge with retinal fibrovascular proliferation and neovasularisation?
| A |
ROP 1 |
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| B |
ROP 2 |
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| C |
ROP 3 |
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| D |
ROP 4 |
Which grade of ROP (Retinopathy of Prematurity) shows a ridge with retinal fibrovascular proliferation and neovasularisation?
| A |
ROP 1 |
|
| B |
ROP 2 |
|
| C |
ROP 3 |
|
| D |
ROP 4 |
Retinopathy of Prematurity is a vasoproliferative retinopathy that affects premature and low-birth-weight infants. ROP stage 3 shows extra retinal fibrovascular proliferation at the ridge between normal and avascular retina.
Stages of Retinopathy of Prematurity are:
STAGE 1: Demarcation line dividing vascualr from avascular retina
STAGE 2: Intraretinal ridge. Line of stage I aquires volume and rises above the surface retina to become a ridge.
STAGE 3: Ridge with extra retinal fibrovascualr proliferation and neovascularization
STAGE 4: Sub-retinal detachment including macula
STAGE 5: Total retinal detachment
A premature baby weighing 1500 g, received prolonged supplemental oxygen therapy and developed retinal venous dilation and arterial tortuosity. The treatment of choice in this stage of retinopathy of prematurity is:
| A |
Laser photocoagulation |
|
| B |
Oxygenation |
|
| C |
Vitreoretinal surgery |
|
| D |
Both a and c |
A premature baby weighing 1500 g, received prolonged supplemental oxygen therapy and developed retinal venous dilation and arterial tortuosity. The treatment of choice in this stage of retinopathy of prematurity is:
| A |
Laser photocoagulation |
|
| B |
Oxygenation |
|
| C |
Vitreoretinal surgery |
|
| D |
Both a and c |
A baby is born prematurely at 28 weeks gestational age with a birthweight of 1200 g. Ventilation with high partial pressures of oxygen is started, but the neonatologist is concerned about the possible development of retinopathy of prematurity (formerly called retrolental fibroplasia). What is the underlying mechanism by which this retinal lesion may develop?
| A |
Ganglion cell degeneration |
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| B |
Inappropriate vascular proliferation |
|
| C |
Optic nerve degeneration |
|
| D |
Pigment deposition in retina |
A baby is born prematurely at 28 weeks gestational age with a birthweight of 1200 g. Ventilation with high partial pressures of oxygen is started, but the neonatologist is concerned about the possible development of retinopathy of prematurity (formerly called retrolental fibroplasia). What is the underlying mechanism by which this retinal lesion may develop?
| A |
Ganglion cell degeneration |
|
| B |
Inappropriate vascular proliferation |
|
| C |
Optic nerve degeneration |
|
| D |
Pigment deposition in retina |
The underlying lesion in retinopathy of prematurity (retrolental fibroplasia) is an inappropriate proliferation of vessels in the inner layers of the retina. If the process is disrupted early, the retina may heal with little residual damage. However, persistence of the process predisposes for permanent damage due to exudation, hemorrhage, and secondary detachment of the retina.
Ganglion cell and optic nerve degeneration are features of retinal damage due to glaucoma. Pigment deposition in the retina is unrelated to retinopathy of prematurity.
Ref: Fletcher E.C., Chong N., Augsburger J.J., Corrêa Z.M. (2011). Chapter 10. Retina. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.
Retinopathy of prematurity is commonly predisposed by-
| A |
Less gestation age |
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| B |
Low birth weight |
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| C |
O2 toxicity |
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| D |
Carbohydrate excess |
Retinopathy of prematurity is commonly predisposed by-
| A |
Less gestation age |
|
| B |
Low birth weight |
|
| C |
O2 toxicity |
|
| D |
Carbohydrate excess |
Ans. is ‘a’ i.e., Less gestation age
Baby born premature at 29 wks on examination at 42 wks with ROP both eyes shows stage 2 zone I plus disease, how will you manage the natient?
| A |
Examination the patient after I week |
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| B |
Laser photocoagulation of both eyes |
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| C |
Laser photocoagulation of worse eye, follow up of othr eye |
|
| D |
Vitreoretinal surgery |
Baby born premature at 29 wks on examination at 42 wks with ROP both eyes shows stage 2 zone I plus disease, how will you manage the natient?
| A |
Examination the patient after I week |
|
| B |
Laser photocoagulation of both eyes |
|
| C |
Laser photocoagulation of worse eye, follow up of othr eye |
|
| D |
Vitreoretinal surgery |
B i.e. Laser photocoagulation of both eyes
All of the following are true for retinopathy of prematurity except:
| A |
Occurs in premature infants due to late crying |
|
| B |
Due to hypoxia there occurs neovascularization followed by fibroproliferation |
|
| C |
End result is bilateral blindness |
|
| D |
Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation |
All of the following are true for retinopathy of prematurity except:
| A |
Occurs in premature infants due to late crying |
|
| B |
Due to hypoxia there occurs neovascularization followed by fibroproliferation |
|
| C |
End result is bilateral blindness |
|
| D |
Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation |
Ans. Occurs in premature infants due to late crying
All of the following are the causes of exudative retinal detachment except:
| A |
Retinopathy of toxaemia of pregnancy |
|
| B |
Retinopathy of prematurity |
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| C |
Exudative retinopathy of Coats |
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| D |
Sympathetic ophthalmia |
All of the following are the causes of exudative retinal detachment except:
| A |
Retinopathy of toxaemia of pregnancy |
|
| B |
Retinopathy of prematurity |
|
| C |
Exudative retinopathy of Coats |
|
| D |
Sympathetic ophthalmia |
Ans. Retinopathy of prematurity
Premature babies can have the following:
| A |
Buphthalmos |
|
| B |
Retinopathy of prematurity |
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| C |
Increased incidence of myopia |
|
| D |
Persistent hyaloid artery |
Premature babies can have the following:
| A |
Buphthalmos |
|
| B |
Retinopathy of prematurity |
|
| C |
Increased incidence of myopia |
|
| D |
Persistent hyaloid artery |
Ans. Retinopathy of prematurity
For preventing Retinopathy of Prematurity, concentration of oxygen should be:
March 2007
| A |
20-30% |
|
| B |
30-40% |
|
| C |
50-60% |
|
| D |
60-70% |
For preventing Retinopathy of Prematurity, concentration of oxygen should be:
March 2007
| A |
20-30% |
|
| B |
30-40% |
|
| C |
50-60% |
|
| D |
60-70% |
Ans. C: 50-60%
Retinopathy of prematurity/ ROP/retrolental fibroplasia /RLF is a disease of the eye that affects prematurely born babies. As such, all preterm babies are at risk for ROP, and very low birth weight is an additional risk factor.
Normally, maturation of the retina proceeds in-utero and at term, the mature infant has fully vascularised retina. However, in preterm infants, the retina is often not fully vascularised.
ROP occurs when the development of the retinal vasculature is arrested and then proceeds abnormally. The key disease element is fibrovascular proliferation. This is growth of abnormal new vessels that may regress, but frequently progresses. Patients with ROP are at greater risk for strabismus, glaucoma, cataracts and myopia later in life.
Retinal vascularization is judged to be complete when vessels extend to the ora serrata.
Retinal examination with scleral depression is generally recommended for patients born before 30-32 weeks gestation, with birthweight 1500 grams or less, or at the discretion of the treating neonatologist. The initial examination is usually performed at 4-6 weeks of life, and then repeated every 1-3 weeks until vascularization is complete (or until disease progression mandates treatment).
The most difficult aspect of the differential diagnosis may arise from the similarity of two other diseases:
- Familal Exudative Vitreoretinopathy which is a genetic disorder that also disrupts the retinal vascularization in full-term infants.
- Persistent Fetal Vascular Syndrome also known as Persistent Hyperplastic Primary Vitreous that can cause a traction retinal detachment difficult to differentiate but typically unilateral.
Prophylaxis is most important. In the management of premature infants, the Pa02 level from the umbilical artery should be monitored, levels of 50-100 mm Hg being regarded as unlikely to produce constriction of immature retinal vessels. Unsatisfactory guides includes ‘pinkiness’, oxygen given at less than 40% in the tent and vascular constriction as seen by ophthalmologist.
In establishes cases:
- Peripheral retinal ablation is the mainstay of ROP treatment. The destruction of the avascular retina is performed with a solid state laser photocoagulation device
- Cryotherapy, a technique in which regional retinal destruction was done using a probe to freeze the desired areas, However, cryotherapy is no longer preferred for routine avascular retinal ablation in premature babies, due to the side effects of inflammation and lid swelling.
- Scleral buckling and/or vitrectomy surgery may be considered for severe ROP
- Intravitreal injection of bevacizumab has been reported as a supportive measure in aggressive posterior retinopathy of prematurity.
A 28-week baby suffered from respiratory distress syndrome at birth. On day 14 of life, he developed sepsis. No other co-morbidity was seen. He should be evaluated for retinopathy of prematurity at what postnatal age?
| A |
2 weeks |
|
| B |
4 weeks |
|
| C |
6 weeks |
|
| D |
8 weeks |
A 28-week baby suffered from respiratory distress syndrome at birth. On day 14 of life, he developed sepsis. No other co-morbidity was seen. He should be evaluated for retinopathy of prematurity at what postnatal age?
| A |
2 weeks |
|
| B |
4 weeks |
|
| C |
6 weeks |
|
| D |
8 weeks |
Ans. b. 4 weeks
