Retinopathy of prematurity

Abstract

Retinopathy of prematurity (ROP) is a vasculoproliferative disease that is seen in the premature babies. Early diagnosis and timely appropriate treatment that can decrease blindness are dependent on high quality neonatal care, an effective screening program and experienced ophthalmologists (Tan et al., 2022). The worldwide incidence of the disease varies according to the level of development. The incidence of ROP in babies older than 32 gestation age is found to be low in developed countries but it increases in the developing countries even in the babies with higher weight or older gestational age. Severe ROP can be seen in the babies at the 34 gestational ages (Ludwig et al., 2017). The duration and concentration of the oxygen (O2) treatment, mechanic ventilation more than one week, fluctuation of the oxygenation, cardiorespiratory problems that affect hemodynemia, patent ductus arteriosus, asphyxia, respiratory distress syndrome, hypercapnia/hypocapnia, fluctuations of the levels of blood gases, hypothermia, metabolic acidosis, bronchopulmonary dysplasia, systemic infections, intracranial hemorrhage, high transfusion number and/or blood exchange, hyperglycemia / insulin treatment, premature anemia treated with erythropoietin, high serum IGF-1 and IGFBP-3 levels, low calorie intake, slow weight gain after birth and multiple pregnancies are independent risk factors (Painter et al., 2015). The location of the lesions is described as retinal zones for staging the disease. The extensity of the disease is described as quadrants and the staging of the disease is done with fundoscopy. There is no new vascular formation in the stages 1 and 2; in which the disease usually spontaneously regresses. Extraretinal fibrovascular proliferation at the ridge starts at the stage 3. Partial and total retinal detachments are seen at the stages 4 and 5, respectively. Although cryotherapy was popular in the past, laser photocoagulation is currently accepted as the standard treatment due to its extensive impact, lesser requirement of anesthesia, lesser inflammatory effects, and decreasing incidence of vision problems (Mintz-Hittner et al., 2011). Anti-VEGF intravitreal injection became popular in the World and Turkey as a result of the search for a less invasive approach. Bevacizumab, Ranibizumap, Pegaptanib, and Aflibercept are the most preferred drugs used as monoclonal Anti-VEGF anticore (Hong et al., 2022). When the disease starts at zone 2, this slow-progressing disease results in total healing or a partial retinal scar. The best prognosis is seen when the ROP begins at zone 3 and total healing is usually seen. Regardless of the treatment requirement, all the babies with ROP history must have an ophthalmological examination at 6 months to 1 year old and one more before the school age.