2014 - 2 Issue

Original article

Screening of Retinopathy of Prematurity (ROP)

Zuzana Prepiaková ORCID
Dana Tomčíková ORCID – Barbora Kostolná ORCID – Anton Gerinec

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Published in Czech and Slovak Ophtalmology: 2014 - 2

Published on website: 22.04.2014

Keywords: retinopathy of prematurity, screening, timing of the examination

Summary

Retinopathy of prematurity (ROP) is abnormal blood vessel development in the retina of the eye in a premature infant that potentially leads to blindness. The guidelines present the timing of initial examination and subsequent reexamination intervals for screening and treating ROP.

References

  1. Costa, M. C. D., Eckert, G. U., Fortes, B. G. B., et al.: Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial. Clinics, 68(2); 2013: 199–204.
  2. Early Treatment for Retinopathy of Prematurity Cooperative Group: Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol, 121(12); 2003: 1684–1694.
  3. Examination before beginning of school attendance We indicate more frequent examinations depending on the objective finding. Children following regression of ROP after treatment: • Every 3 months over the course of 1 year, • Every 6 months up to the age of 6 or according to the objective finding, • Long-term care 1x per year, it is necessary to instruct the parent concerning the risk of amotio and self-examination at home. Gestation age (weeks) Postnatal age at 1st examination Post-conception age at 1st examination 22 9 31 23 8 31 24 7 31 25 6 31 26 5 31 27 4 31 28 4 32 29 4 33 30 3 33 31 3 34 32 3 35 Table 1 Timing of first eye examination in premature infants – adapted according to the recommendations of the American Academy of Pediatrics 2013 (3). Gestation age = duration of pregnancy in weeks, postnatal age = age in weeks from date of birth, post-conception age = gestation age + postnatal age Table 2 Timing of follow-up eye examinations for premature infants according to finding on
  4. Treatment of acute retinopathy of prematurity is indicated for high risk ROP. In pre-threshold stage: • Zone I: ROP any stage with plus form, • Zone I: ROP 3 without plus form, • Zone II: ROP 2 or ROP 3 with plus form. In threshold stage of ROP: ROP stage 3 which continuously affects a scope of 5 hours on the clock face or a cumulative scope of 8 hours in zone I or II, with presence of plus form of the disease. Treatment should be implemented within 72 hours of determination of diagnosis, thus upon stipulating the date for the next examination, if we expect progression of the finding and it shall be necessary to transport the child to a specialised workplace, it is necessary to reckon with this time.
  5. In monotherapy with an intravitreally applied anti-VEGF, regular observation is indicated every week until the end of vascularisation of the retina, with regard to the degree of probability of recurrence of ROP. With regard to the fact that none of the anti-VEGF preparations have yet been approved for use in paediatric practice for the treatment of ROP, and the long- -term adverse drug reactions are not precisely known, it is necessary before application to obtain the informed consent of the parent to the administration of off-label therapy (therapy outside of the indication criteria).
  6. The results of screening are thoroughly recorded in writing, whereas it is important to ensure communication with the parent, who should be informed about the risks of impairment of sight even despite adequate therapy in the case of the development of a severe type of ROP.
  7. With regard to the degree of probability of development of later ocular complications of prematurity (myopia, anisometropia, amblyopia, strabismus, atrophy of ONH…) in children who have been included in screening of ROP, they remain within the care of the ophthalmologist, and it is necessary to inform the patient in this regard. Subsequent ophthalmological observation of premature infants is recommended: Children without ROP and after spontaneous regression of ROP: