12. Retinopathy of Prematurity
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What is ROP?
retinal bv development in premature low birth infacnts
What happens in retinal development in prematurity?
- normal BV growth stops
- in utero: avasc ret produces VEGF to stimulate migration of vessels to temporal periphery
- premature: VEGF is downregulated by hyperoxia and vessel migration is halted
- then reintroduced to hypo-xia-> excessive VEGF-> neovascular complications
What are the key features of ROP?
- avascular peripheral retina
- demarcation line between vasc and avasc retina
What are the stages of ROP?
- 1: demarcation line
- 2: ridge arises
- 3: extra retinal fibrovascular proliferation
- 4: partial retinal detachment
- 5: retinal detachment
80% of cases spontaneously
Plus disease in ROP?
- no dilation of pupil: engorgement of iris vasc
- vitreous haze
- dilation of veins tortuosity of arteries
- preretinal/vietrous haemmorhage
- abnormal vessel growth on iris
- leukocoria: Rb
- exudative retinal detachment: coat's (uni and boys)
- minimise pre term labour
- minimum use of O2
- prevention of complications
tx for ROP?
- laser photocoagulation: destroys new vessels and seals leaks
- cryotherapy: destroy ab tissue, reduces risk of RD
- scleral buckle and vitrctomy
- VEGF inhibitors
Complications of ROP?
- poor va
- macular dragging by scar tissue
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