ROP is defined as a disorder of the developing retina of low birth weight, preterm infants potentially leading to blindness in a small but significant percentage of those infants. It is thought to be caused by disorganized growth of retinal blood vessels which may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but may lead to blindness in serious cases. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP. This condition is slowly coming to light as a result of rapidly improving standards of neonatal care which makes the survival of such premature children a reality.
Normally, vascularization of the retina starts from the optic disc and progresses towards the periphery and in most of the normal neonates its almost complete, However, in preterm infants, the retina is often not fully vascularized and ROP occurs when the development of the retinal vasculature is arrested and then proceeds abnormally. Multiple factors can determine whether the disease progresses, including overall health, birth weight, the stage of ROP at initial diagnosis, and the presence or absence of "plus disease". Supplemental oxygen exposure, while a risk factor, is not the main risk factor for development of this disease.
Patients with ROP are at greater risk for strabismus, glaucoma, cataracts and myopia later in life, and should be examined yearly to help prevent and treat these conditions. An expert group of Ophthalmologists in India have formulated guidelines regarding this condition.
Dilated fundus examination with an indirect ophthalmoscope using scleral depression is most important in diagnosing ROP. Examination of the retina of a premature infant is performed to determine how far the retinal blood vessels have grown (the zone), and whether or not the vessels are growing flat along the wall of the eye (the stage). Once the vessels have grown into Zone 3 (outermost zone) it is usually safe to discharge the child from further screening for ROP.
Whom to screen/examine for ROP?
Other factors where screening must be done forchildren with birth weight < 2000 grams or Gestational age < 37 weeks include
When to screen for ROP?
All children must be screened at least once by 31 weeks gestational age or 3-4 weeks after birth (whichever is earlier) In children with birth weight < 1200 grams or born before 24 weeks gestational age, examination must be scheduled at 2- 3 weeks post delivery
There is no need for examination within 2 weeks of delivery as the normal retinal maturation would not be complete during this period
1. Laser photocoagulation:
Peripheral retinal ablation is the mainstay of ROP treatment. The treatment of the avascular retina is performed with a solid state laser photocoagulation device, as these are easily portable to the operating room or neonatal ICU.
Doctor performing ROP LASER in neonatal ICU
An earlier technique in which regional retinal destruction was done using a probe to freeze the desired areas. However, when laser treatment is available, Cryotherapy is no longer preferred for routine avascular retinal ablation in premature babies, due to the side effects of inflammation and lid swelling.
3. Intravitreal injection:
Intravitreal injection of bevacizumab (Avastin) has been reported as a supportive measure in aggressive posterior retinopathy of prematurity.
4. Scleral buckle:
The silicone band (scleral buckle) is placed around the eye. This brings the wall of the eye into contact with the detached retina, allowing the retina to re-attach.
Vitrectomy and/or scleral buckling surgery may be considered for severe ROP (stage 4 and 5) for eyes that progress to retinal detachment. Few centers in the world specialize in this surgery, because of its attendant surgical risks and generally poor outcomes.
“I was highly impressed by the over all management of large number of patients properly guided and investigated very effectively. Staff at the reception and all management levels well trained and helpfully caring hardworking. My salute to all involved for starting proper management of large number of patients.”
“The staff was very much kind and the clinic setup was very beautiful. Very nicely managed. I definitely would like to recommmed this clinic to my near and dear ones. Thanks once again for taking care of me!”
“Excellent in all respects. Very clean and has well maintained toilets. The staff are very friendly and helpful. Overall extremely satisfying experience.”
“My dad had a retinal detachment which was found overnight and he had to undergo retinal detachment surgery (vitrectomy) within 7days. He flew down to Hyderabad and directly to Raja Ram Reddy. He suggested to go for surgery the very next day. It was a successful surgery and my dad got discharged in the evening. He is very cordial and really nice in speaking. He is calm cool minded. A perfect doctor to consult.”
“I'm very happy with the drs approach and very patiently examined I have great confidence in Dr reddy its been three years that I come to Dr reddy all the way from Kolkata wish we have doctors like him at Kolkata too.”
ANIL KUMAR AGARWAL
“Best..Wonderful clinic with very helpful staff and well experienced and caring doctors like Dr.Srinivas and Dr.R.R.Reddy... I took my father who is diabetic and heart patient also for his eye surgery and the doctors guided us v.nicely to take care of him b4 & after surgery and my father's eyes r perfect...mashallah...thanks to God and then the neoretina team...Well done...keep spreading the light of vision in the life of others too. ”
“I know her from since 3 years she diagnosed the retina detachment in my left eye and explained about the treatment. She works for NEORETINA eye care institute which is located in the nampally hyderabad. She clarifies each and every doubt of the patient patiently without any irritation. I mean some doctors gets irritated when the patient asks more questions but that's not the case with alka Rani madam. I suggest to all who are suffering from eye disorders to visit neoretina for timely treatment and speedy recovery.”
“Excellent attention to my eye problem doctor Abhilasha Baharani at Neo Retina Eye Care Institute was very cooperative she is very echo friendly clear voice n determined i will in sha Allah refer to all of my near n dear to visit her if any one having eye problems i appreciate thanks a lot.”
“Dr. Raja is one of the foremost experts in retina issues. He is very approachable at the same time gives you valuable advice.”