Pathophysiology of
Retinopathy of Prematurity
ROP:Risk Factors
 Prematurity
--- Gestational age: less than 34 weeks
 Low Birth Weight: less than 2000 gm especially less
than 1250gms
 Oxygen therapy : Fluctuating oxygen saturation
Contd…







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Other factors :
Sepsis,
Multiple blood transfusions,
Multiple births,
Hyaline membrane disease,
Use of aminophylline, antibiotics,
Apnoeic spells,
Low pH
Pathophysiology
At 16 wks-Mesenchyme growth starts as precusrsor of blood
vessels
 Blood vessels reache Nasal ora by 36 wks and Temporal ora by
40 wks

High O2 obliterate newly formed capillaries, damaging
endothelium.
 Reduce blood flow due to vasoconstriction

Pathophysiology

Most of the time- no new vessel, normal
vasculogenesis-regressed ROP(90%)

Neovascular proliferations- shunt cells break
through ILM & grow in vitreous
Pathogenesis

PhaseI: 22 Wk to 30 PM wk. Relative Hyperoxia, decreased VEGF level.
- Strategy: Prevention and Early treatment

Phase II : 31-44 PM wk Relative hyperoxia, increased VEGF level.
- Strategy: Treatment.
Normal
O2,
normal
VEGF,
Normal
Intrauterine
growth
PhaseI, high 02,
low VEGF
Premature
birth
Ph2, low 02,
high VEGF
Stage 0, Stage1,
Stage2
Stage3
treatment
StageV
ETROP Criteria for Treatment
Type I- ZoneI, Any stage,+
- ZoneI, Stage3, No +
- Zone II, stage2 or 3, +
TREAT
Type II- Zone I, Stage1 or 2, No +
- Zone II, Stage3, No +
OBSERVE
Early Treatment of Retinopathy of Prematurity Cooperative
Group. Revised indications for the treatment of retinopathy of
prematurity. Arch Ophthalmol 2003;121: 1684-96
FVP
Zone 1 any stage with +
Zone II, Stage III +
Zone II, Stage II +

ROP ANIMATION 10-31-03.mpeg
THANK YOU
BABY INFORMATION SHEET
Name of hospital
AMRI
RSV
B NEOTIA
Date of ph
received
New baby 7/23/2012 yes
Review baby No of baby
1
AT 9AM
7/23/2012
AT 9AM
7/23/2012 YES
NIL
AT 12PM
MARTI BHAVAN
7/23/2012
NIL
AT 9AM
7/23/2012
NIL
PARK CLINIC
WOOD LANDS
AT 9AM
7/23/2012 YES
Next follow up
Procedure
ROP SCREENING
NIL
AT12PM
7/23/2012
WEST BANK
Follow up
REVIEW
AT 8.45AM
** *PLEASE CALL TO EACH HOSPITAL ON EVERY MONDAY AND THURS DAY
*** OUT SIDE CHECKING DAY- TUES DAY AND FRIDAY
4
ROP SCREENING
2
ROP SCREENING
Rop Handout
Chasing dropouts

Maintain follow up schedule in Excel worksheet with reminders

ROP Cards updated at every visit with mention of next date of visit

Call parents in case of dropout
-- At least 2 phone calls & noted the time & date.
-- Registered letter

Call neonatologist
Priyamvada Birla Aravind Eye Hospital (Till 2014 NOVEMBER)

Total baby seen -6750

Rop baby laser: eyes-278

Avastin-30

Rop surgery done-8

StageV, referred- 10

Total StageV, Blind & inoperable= 25
Stage 3 , lasered