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Retinopathy of Prematurity (ROP)
Retinopathy of prematurity (ROP) is a retinal disease that can occur in prematurely born children. The blood vessels of the retina normally develop only in the last weeks of pregnancy. In premature babies, this vascular development is not yet complete, and uncontrolled, abnormal vessel growth can occur that damages the retina and, in the worst case, leads to blindness.
Risk Factors
- Very short gestational age: The more immature the child, the higher the risk. Particularly affected are children born before the 32nd week of pregnancy.
- Very low birth weight: Children under 1500 grams birth weight have an increased risk.
- Oxygen therapy: The administration of additional oxygen, which is often life-saving in the neonatal intensive care unit, can promote abnormal vessel growth.
- Other factors such as infections, blood transfusions, and the child's general immaturity can also play a role.
Stages of the Disease
ROP is classified into five stages:
- Stage 1: Mild change: a boundary line between the vascularized and the not yet vascularized retina.
- Stage 2: The boundary line becomes a raised ridge.
- Stage 3: Abnormal blood vessels grow from the ridge into the vitreous body.
- Stage 4: Partial retinal detachment.
- Stage 5: Complete retinal detachment: the most severe course.
In addition, the location (zone) and extent of the disease are documented. A special form, "Plus Disease", is characterized by dilated, tortuous vessels and indicates an aggressive disease.
Screening for Retinopathy of Prematurity
Early detection is crucial. All premature babies who meet the criteria (usually born before the 32nd week or weighing less than 1500 grams) are systematically examined:
- The first examination usually takes place 4–6 weeks after birth.
- The examination is performed by a specialized ophthalmologist, often still in the neonatal intensive care unit.
- The pupils are dilated, and the retina is examined with a special instrument (indirect ophthalmoscope) or a retinal camera.
- Follow-up examinations are planned at close intervals depending on the findings.
Treatment
Many mild forms of ROP regress spontaneously and do not require treatment. For more severe stages, the following therapies are available:
- Laser coagulation: The standard treatment for ROP requiring intervention. With a laser, the not yet vascularized peripheral retina is sealed to interrupt the growth signal for abnormal vessels.
- Intravitreal anti-VEGF injection: A medication is injected directly into the vitreous body, inhibiting the growth factor VEGF and thus stopping abnormal vessel growth. This method is increasingly being used, especially for aggressive forms.
- Surgical procedures: For advanced retinal detachment (stages 4–5), vitrectomy (vitreous body surgery) may be necessary.
Long-Term Care
Even after successful treatment or spontaneous regression of ROP, affected children need long-term ophthalmological care. Premature babies have an increased risk of:
For Parents
If your child was born prematurely, the treatment team will organize the necessary eye examinations. The examination may feel stressful for you as a parent, but it is low in pain and lasts only a few minutes. Timely detection and treatment of ROP has significantly improved the visual prognosis for premature babies in recent decades. Be sure to keep the recommended follow-up appointments, even after discharge from the hospital.
