ROP - Home Eye Care

Treatment for Retinopathy of Prematurity

Treatment should be reserved only for severe disease and not recommended for milder clinical presentations (Stage I and II)

The ultimate aim of treatment is to control the abnormal growth of blood vessels, thus saving the vision by avoiding scarring or cicatrisation.

Understanding Screening for Retinopathy of Prematurity

Fundamentals for ROP Screening:

Requires all infants < 34 weeks or high-risk infants < 36 weeks
Often at least 2 examinations should be performed
Infants who are at high risk for progression of disease must be examined
- Any zone 1 disease
- Zone II with stage 2+ or 3 ROP
- Zone II/III with Stage 3+ ROP occupying fewer clock hours than defined in threshold disease
Infants with less severe disease in Zone II or disease restricted to Zone III
should be examined once in 2 weeks
Infants with threshold ROP should receive peripheral ablation therapy
within 72 hours of diagnosis

Requirements for Diagnosis or Screening:

Indirect ophthalmoscope (Gold standard)/ portable contact fundus camera

20D or 28 D lens
Scleral depressor (schoket)
Eye speculum (alphonso/wire)
Proparacaine eye drops
Tobramycin/ lubricating eye drops
Half dilution of tropicamide with phenylephrine eye drops

Treatment Modality for Retinopathy of Prematurity

Cryotherapy

Cryotherapy is an ancient procedure by which the physicians uses a pen like instrument “cryoprobe” to freeze the surface of the retina.

This instrument is used to generate a freezing temperature to scar the surface of Retina.

Laser Therapy

Laser continues to be the gold standard approach for treatment of ROP. It is performed through the laser indirect ophthalmoscope delivery system. These lasers burn the periphery of the retina to control the growth of undesirable blood vessels. This therapy is performed on Infants with Stage 3 ROP. Both Cryotherapy and photocoagulation work by scaring the peripheral retina. Both the methods are advised only for Stage 3 ROP.

Scleral Buckle

A silicone band is placed over the eye. The sclera is brought closer to the detached retina so as to allow retinal reattachment.
This treatment procedure helps the retina to regain its base position.
An infant who undergoes Scleral Buckle will require a secondary procedure later to remove the band in a month or within a year.
This is one of the advanced ROP treatment prescribed for Stage 4 or 5 ROP.

Vitrectomy

It is performed for infants with Stage 4 or 5 ROP. This advanced level of surgery helps in removing the vitreous and is replaced by saline. During this procedure the contracted vitreous is removed along with the scar tissue on the retinal surface thereby releasing all tractional components. This helps the retina to relax and return to its original position. Sometimes the crystalline lens within the eye is also removed to perform better clearance of the vitreous.

Another benefit of a vitrectomy is the removal of all abnormal growth factors present within the eye and this further reduces the growth of these undesirable blood vessels.

Anti VEGF proteins

Monoclonal antibodies and antibody fragments are now being routinely used for the management of ROP. Anti VEGF proteins like Ranibizumab, Bevacizumab and Aflibercept have changed the paradigm in treatment of ROP. They have tremendous potential to become the new gold standard in the management of ROP.

These proteins have the added advantages of:

• Immediate response

• Reduction of Myopia (-1.0)

• Unlike retinal laser or cryotherapy, there is no retinal destruction

• Side effect profiles were seen in early days and are manageable

• Relative Quick and easy process of administration