International Classification of Retinopathy of Prematurity ...
Retinopathy of Prematurity Geoffrey T. Tufty, MD Sanford Clinic Ophthalmology.
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Transcript of Retinopathy of Prematurity Geoffrey T. Tufty, MD Sanford Clinic Ophthalmology.
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Retinopathy of PrematurityGeoffrey T. Tufty, MD
Sanford Clinic Ophthalmology
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Failure of the peripheral retina to vascularize
Definition
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ROP
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To understand the etiology of ROP To understand the anatomy of the eye To understand the stages/severity of ROP To understand the zones/location of ROP To understand the screening guidelines for
ROP To understand the treatment options for ROP To understand the long term affects of ROP
Objectives
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ROP-historical
1942- Terry Leading cause of
childhood blindness Retro lental
fibroplasia
4 million premature babies born each year
14,000 have ROP 90% of those are mild
cases and resolve
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Retro lental fibroplasia
Fibrous mass behind the lens is detached retina
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Risk factors
Low birth weight Early gestational age Anemia Respiratory distress Poor weight gain
Blood transfusion Multiples Intraventricular
hemorrhage Low vitamin E ? light exposure
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When to Screen??
BW <1500 grams <32 weeks >32 weeks with a
difficult clinical course
4 weeks of age or 31 weeks which ever is first
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Normal Retinal Development
Nasal(32 weeks) then temporal (40 weeks)
VEGF Stimulates normal
development-reduced by hyperoxia-cessation of growth
Hypoxic retina upregulates VEGF and thus ROP
Immature retina-hyperoxia-produces VEGF and neo grows- ROP
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Anatomy of the Eye
Tear film Cornea Iris Lens Vitreous Retina-macula Optic nerve
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Retina
Normal retina fully developed
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Tools of the trade
Dilating drops-cyclomydril
Anesthetic drops
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Tools of the trade
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Indirect Ophthalmoscope
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Good help
You need to swaddle the baby and take your time but be efficient.
Get a good look. Using the “force”
does not work
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Ret-Cam
Used for retinal photos to detect ROP and other forms of retinal pathology
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Let’s set the Stage
Stages are the severity of the ROP
The higher the stage the worse the disease
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Stage 1 ROP
A demarcation line between normal retinal vasculature and avascular retina
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Stage 1
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Stage 1 ROP
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Stage 2 ROP
The demarcation line between vascular retina has increased volume
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Stage 2 ROP
The demarcation line has volume to it.
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Stage 3 ROP
Neovascularization on the dividing line between vascular and avascular retina
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Stage 3 ROP
Continuous neovascularization
Popcorn Sausage
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Stage 3 ROP
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Stage 4A ROP
Extra foveal retinal detachment
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Stage 4A ROP
Peripheral retina is being pulled off of the attachments-traction
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Stage 4B ROP
Traction and detachment of the fovea-center vision
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Stage 5 ROP
Bad- total tractional retinal detachment
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Stage 5 ROP
Poor overall visual outcomes despite aggressive treatment
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Plus Disease
Increase in venous and arteriolar dilation
Due to blood shunting
Indicates severity
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No Zoning Out
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Get into the Zone
Location of ROP in the eye
Higher the zone-the better
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Zone I
A circle with the optic nerve as the center and extends twice the distance from the optic disc to the macula
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Zone II
From zone I to the nasal peripheral retina
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Zone III
Temporal retinal crescent
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Follow up Exams
1 week Early zone II Zone I stage 1 or 2 progression
2 weeks Zone II immature Zone II stage 1 or 2 Zone II no ROP
3 weeks Zone III
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When to treat??
Zone 1 ROP any stage with plus disease
Zone I stage 3 no plus
Zone II stage 2 or 3 with plus
Should be treated within 72 hours
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Treatment
In the NICU? In the OR?
Sit down with family and cover everything-layman’s terms
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Treatment
Cryotherapy
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Cryotherapy
Cryo ROP study in 1986 reduced unfavorable outcomes from
Eyes are red and sore
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Cryotherapy
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Laser
Portable Learning curve Less painful
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Laser
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Laser
ROP may get worse before it gets better
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Avastin
Anti VEGF therapy
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Injection
Dosage- half the adult dose
30 g needle Betadine Pars plana
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Avastin
Risks of injection Infection Cataract Normal
vascularization
What is the correct dosage
Frequency Developing brain and
organs Long term follow up
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Vitrectomy
Surgical reattachment of the retina 40% of stage 5 2/3rds of stage 4
Visual outcomes are generally poor
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Risk Factors of Treatment
Blindness Retinal detachment-
traction Strabismus Myopia Anisometropia Cataract Amblyopia Low vision
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Aids
Glasses Low vision aids
Magnifiers Computers/tablets CCTV Large print books Good lighting
Low vision teachers School for the blind
Good communication with parents and teachers
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Questions???
When it comes to ROP there is no zoning out. If you do, you will set the stage for disasterThank you!!!