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Retinopathy of prematurity for medical students.pptx

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This document discusses retinopathy of prematurity (ROP), a disease affecting the retinal vasculature in preterm infants. It defines ROP, lists its risk factors such as prematurity and oxygen exposure. The document describes the normal development of the retinal vasculature and the international classification system for ROP based on location and severity. It outlines screening guidelines and treatment approaches for ROP, including laser therapy and anti-VEGF injections, aiming to prevent blindness.

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罪近近鍾戟 Retinopathy of prematurity ASST. PROF. DO SEIHA KHMER SOVIET FRIENDSHIP HOSPITAL DEPARTMENT OF OPHTHALMOLOGY
Summary of Dr Do Seiha Lectures Diabetic Retinopathy Retina Vascular Occlusive Disease ( Vein and Retina Occlusion) Hypertensive Retinopathy Optic Nerve Diseases Retinopathy of Prematurity
Learning Objectives& Contents Background & Rationale Definition Risk Factors Retina vascularization development International Classification by sites and stages Prevention of blindness from ROP ROP Screening Treatment
ROP a closer look
罪近近鍾戟 Retinopathy of prematurity- Background History Frequently leads to no light perception, Narrow window of opportunity for treatment First epidemic in 1950s increased survival of premature babies + oxygen Second epidemic better survival of very premature babies Now exceptionally good neonatal care, with treatment and screening programmes 10-15% of blindness in industrialised countries;
罪近近鍾戟 Retinopathy of prematurity Disease of the retinal vasculature in pre-term babies Exact pathogenesis is unknown, likely due to increased production of VEGF which triggers abnormal vascularization in the retina Affects 50% of babies <1250g at birth , 10% will go on to develop more severe disease
近戟 Risk Factors Prematurity (esp. < 32 week gestation) , Low body weight (esp. < 1500g) Supplemental oxygen (saturation 88-93 % is associated with a significant reduction of ROP) Hypoxemia ( Level of O2 level in blood too low) Hypercarbia
ROP Stages
Retinal vascularisation during development 16 weeks GA 26 weeks GA 36 weeks GA 40 weeks GA
International Classification of ROP - Site - Zones 1- 3 - Severity - Stages 1-5
Classification of ROP - by zone (site)
Retina Zones
Retina Zone in ROP
International Classification of ROP by stages There are five stages of ROP, o Stage 1: Demarcation line present o Stage 2: Ridge present o Stage 3: Fibrovascular proliferation o Stage 4: Partial retinal detachment o Stage 5: Total retinal detachment
International Classification of ROP by stages Cont Stage I : Demarcation line - between vascularized and avacular retina
International Classification of ROP by stages Cont Stage II : Consist of a ridge an elevation and thickening of the retina in the region of the demarcation line
International Classification of ROP by stages Cont Stage III : Fibrovascular proliferation from the region of the ridge extends into the vitreous
International Classification of ROP by stages Cont Stage IV : Partial Retinal Detachment tractional or exudative or both
International Classification of ROP by stages Cont Stage V : Total Retinal Detachment
Diagnosis & Differential Diagnosis ROP leukocoria can be a sign of ROP Best way is refer to a pediatric ophthalmologist. Other Eye Condition Retinoblastoma Congenital Cataract
Which babies should be examined .. GUIDELINES o ALL babies born < 30 week of gestation o ALL babies born weighing less than 1500g o Babies born 30-36 weeks, babies 1300-1800g Who received supplemental oxygen o Babies with prolonged supplemental oxygen exposure EXAM SHOULD BE PERFORMED BY 5 WEEKS OF AGE
Treatment o Stages 1 and 2 can be observed with regular exam q 1-2 weeks usually regresses spontaneously o Stages 3 and higher are treated w/ laser ablation or cryotherapy to prevent further vascular proliferation Laser and/or cryo Both give goods results Painful: -needs analgesia, and sedation or GA Intra Vitreal Injection ( Avasin..)
Retinopathy of prematurity for medical students.pptx
Prevention of blindness from ROP PRIMARY PREVENTION: Prevent premature birth (teenage pregnant / antenatal care) Excellent neonatal care, with close oxygen monitoring SECONDARY PREVENTION: Screening for threshold disease Treatment of threshold disease (laser or cryo) Follow up to treat refractive errors and strabismus TERTIARY PREVENTION: Retinal surgery for stage 4 and 5 gives poor functional results
References Basic Ophthalmology- Essentials for Medical Students- American Academy of Ophthalmology The Wills Eye Manual : Office and Emergency Room Diagnosis and Treatment of Eye Diseases Clinical Ophthalmology- Kanski Lecture Notes in Ophthalmology, Retina in systemic disease : a color manual of ophthalmoscopy / Homayoun Tabandeh, Morton F. Goldberg 2009 25
References Recommended Digital Leaning website Clinical Education - American Academy of Ophthalmology (aao.org) Eye Health - American Academy of Ophthalmology (aao.org) The easy way to learn ophthalmology - TimRoot.com Smart Phone Plate form The Eye Handbook: A Mobile App in Ophthalmic Medicine https://eyepatient.net/ 26

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Retinopathy of prematurity for medical students.pptx

  • 1. 罪近近鍾戟 Retinopathy of prematurity ASST. PROF. DO SEIHA KHMER SOVIET FRIENDSHIP HOSPITAL DEPARTMENT OF OPHTHALMOLOGY
  • 2. Summary of Dr Do Seiha Lectures Diabetic Retinopathy Retina Vascular Occlusive Disease ( Vein and Retina Occlusion) Hypertensive Retinopathy Optic Nerve Diseases Retinopathy of Prematurity
  • 3. Learning Objectives& Contents Background & Rationale Definition Risk Factors Retina vascularization development International Classification by sites and stages Prevention of blindness from ROP ROP Screening Treatment
  • 5. 罪近近鍾戟 Retinopathy of prematurity- Background History Frequently leads to no light perception, Narrow window of opportunity for treatment First epidemic in 1950s increased survival of premature babies + oxygen Second epidemic better survival of very premature babies Now exceptionally good neonatal care, with treatment and screening programmes 10-15% of blindness in industrialised countries;
  • 6. 罪近近鍾戟 Retinopathy of prematurity Disease of the retinal vasculature in pre-term babies Exact pathogenesis is unknown, likely due to increased production of VEGF which triggers abnormal vascularization in the retina Affects 50% of babies <1250g at birth , 10% will go on to develop more severe disease
  • 7. 近戟 Risk Factors Prematurity (esp. < 32 week gestation) , Low body weight (esp. < 1500g) Supplemental oxygen (saturation 88-93 % is associated with a significant reduction of ROP) Hypoxemia ( Level of O2 level in blood too low) Hypercarbia
  • 9. Retinal vascularisation during development 16 weeks GA 26 weeks GA 36 weeks GA 40 weeks GA
  • 10. International Classification of ROP - Site - Zones 1- 3 - Severity - Stages 1-5
  • 11. Classification of ROP - by zone (site)
  • 14. International Classification of ROP by stages There are five stages of ROP, o Stage 1: Demarcation line present o Stage 2: Ridge present o Stage 3: Fibrovascular proliferation o Stage 4: Partial retinal detachment o Stage 5: Total retinal detachment
  • 15. International Classification of ROP by stages Cont Stage I : Demarcation line - between vascularized and avacular retina
  • 16. International Classification of ROP by stages Cont Stage II : Consist of a ridge an elevation and thickening of the retina in the region of the demarcation line
  • 17. International Classification of ROP by stages Cont Stage III : Fibrovascular proliferation from the region of the ridge extends into the vitreous
  • 18. International Classification of ROP by stages Cont Stage IV : Partial Retinal Detachment tractional or exudative or both
  • 19. International Classification of ROP by stages Cont Stage V : Total Retinal Detachment
  • 20. Diagnosis & Differential Diagnosis ROP leukocoria can be a sign of ROP Best way is refer to a pediatric ophthalmologist. Other Eye Condition Retinoblastoma Congenital Cataract
  • 21. Which babies should be examined .. GUIDELINES o ALL babies born < 30 week of gestation o ALL babies born weighing less than 1500g o Babies born 30-36 weeks, babies 1300-1800g Who received supplemental oxygen o Babies with prolonged supplemental oxygen exposure EXAM SHOULD BE PERFORMED BY 5 WEEKS OF AGE
  • 22. Treatment o Stages 1 and 2 can be observed with regular exam q 1-2 weeks usually regresses spontaneously o Stages 3 and higher are treated w/ laser ablation or cryotherapy to prevent further vascular proliferation Laser and/or cryo Both give goods results Painful: -needs analgesia, and sedation or GA Intra Vitreal Injection ( Avasin..)
  • 24. Prevention of blindness from ROP PRIMARY PREVENTION: Prevent premature birth (teenage pregnant / antenatal care) Excellent neonatal care, with close oxygen monitoring SECONDARY PREVENTION: Screening for threshold disease Treatment of threshold disease (laser or cryo) Follow up to treat refractive errors and strabismus TERTIARY PREVENTION: Retinal surgery for stage 4 and 5 gives poor functional results
  • 25. References Basic Ophthalmology- Essentials for Medical Students- American Academy of Ophthalmology The Wills Eye Manual : Office and Emergency Room Diagnosis and Treatment of Eye Diseases Clinical Ophthalmology- Kanski Lecture Notes in Ophthalmology, Retina in systemic disease : a color manual of ophthalmoscopy / Homayoun Tabandeh, Morton F. Goldberg 2009 25
  • 26. References Recommended Digital Leaning website Clinical Education - American Academy of Ophthalmology (aao.org) Eye Health - American Academy of Ophthalmology (aao.org) The easy way to learn ophthalmology - TimRoot.com Smart Phone Plate form The Eye Handbook: A Mobile App in Ophthalmic Medicine https://eyepatient.net/ 26