Retinopathy of Prematurity

What Is Retinopathy of Prematurity?

Retinopathy of prematurity (ROP) is an eye disease that can happen in premature babies. It causes abnormal blood vessels to grow in the retina, and can lead to blindness.

What Happens in Retinopathy of Prematurity?

Retinopathy (ret-in-AH-puh-thee) of prematurity makes blood vessels grow abnormally and randomly in the eye. These vessels tend to leak or bleed, leading to scarring of the retina, the layer of nerve tissue in the eye that lets us see.

When the scars shrink, they pull on the retina, detaching it from the back of the eye. Because the retina is a vital part of vision, its detachment will cause blindness.

What Causes Retinopathy of Prematurity?

During pregnancy, blood vessels grow from the center of a developing baby's retina 16 weeks into the mother's pregnancy, and then branch outward and reach the edges of the retina between 8 months into the pregnancy and when the baby is full term. In babies born early, normal retinal vessel growth may be disrupted and abnormal vessels can develop. This can cause leaking and bleeding into the eye.

ROP has no signs or symptoms when it first develops in a newborn. The only way to detect it is through an eye exam by an ophthalmologist .

How Is Retinopathy of Prematurity Treated?

Some cases of ROP are mild and correct themselves. But others progress to scarring, pulling the retina away from the rest of the eye. These cases need surgery to prevent vision loss or blindness.

ROP surgery stops the growth of abnormal blood vessels. Treatment focuses on the peripheral retina (the sides of the retina) to preserve the central retina (the most important part of the retina). ROP surgery involves scarring areas on the peripheral retina to stop the abnormal growth and eliminate pulling on the retina.

Because surgery focuses on the peripheral retina, some amount of peripheral vision may be lost. However, by preserving the central retina, the eye can still do vital functions like seeing straight ahead, distinguishing colors, reading, etc.

Types of Retinopathy of Prematurity Surgery

The most common methods of ROP surgery are:

• laser surgery: This is done most often for ROP. Small laser beams scar the peripheral retina. This procedure (also called laser therapy or photocoagulation) lasts about 30–45 minutes for each eye.
• injection: A medicine is injected into the eye. This might be done as an alternative to, or along with, laser surgery. This is a newer treatment and results are promising, often allowing the blood vessels to grow more normally. Research is ongoing to determine the long-term side effects of the medicine on premature infants.

For advanced cases of ROP with retinal detachment, these methods are used:

• scleral buckling: This involves placing a flexible band, usually made of silicone, around the circumference of the eye. The band goes around the sclera, or the white of the eye, causing it to push in, or "buckle." This, in turn, pushes the torn retina closer to the outer wall of the eye. This surgery takes 1–2 hours.

• vitrectomy: This complex surgery involves replacing the vitreous (the clear gel in the center of the eye) with a saline (salt) solution. This allows for the removal of scar tissue and eases tugging on the retina, which stops it from pulling away. Vitrectomy can take several hours.

Your baby's ophthalmologist will talk with you about which ROP surgery method is best.

What Happens in Retinopathy of Prematurity Surgery?

Your baby's pediatric ophthalmologist will describe the procedure and answer your questions.

ROP surgery is usually done with a child under either general anesthesia (medicine that causes a deep sleep-like state) or sedation (the child is unaware of the procedure, but isn't as deeply sedated as with general anesthesia).

• Laser surgery can be done either at the child's bedside with sedation and pain medicine or under general anesthesia in an operating room.
• Injections usually are done at the bedside with the child under topical (local) anesthesia.
• Scleral buckle and vitrectomy surgeries require general anesthesia, so they are done in an operating room.

For all procedures, the baby's breathing and heart rate is closely watched during the surgery.

Doctors give the baby eye drops to dilate the pupil(s) before the procedure. During the surgery, a tool called an eyelid speculum is gently inserted under the eyelids to keep them from closing.

The eye will be covered with a patch after scleral buckling and vitrectomy, but not after laser surgery or an injection. Whether a hospital stay is needed depends on the child's medical condition and age at the time of surgery.

What Else Should I Know?

If a hospital stay isn't needed, you can take your child home about an hour after the procedure. Follow-up care for ROP surgery includes giving your child eye drops (to prevent infection and/or inflammation) for at least a week.

To make sure the eyes heal properly and that ROP hasn't returned, the ophthalmologist will schedule follow-up eye exams. These usually happen every 1–2 weeks. For scleral buckling, the ophthalmologist must examine the buckle every 6 months to account for a child's growing eye.

The goal of ROP surgery is to stop the progression of the disease and prevent blindness. ROP surgery has a good success rate, but not all babies respond to treatment. Up to 25% of babies who have ROP surgery might still lose some or all vision.

With all types of ROP surgery, a degree of peripheral (side) vision may be lost. And even if the ROP stops progressing, vision still can be affected. Because some vision loss and complications can happen, any child who has had ROP surgery should have regular, yearly eye exams well into adulthood.

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