Retinopathy of prematurity: Past, present and future

Abstract

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.

Keywords: Anti vascular endothelial growth factor; Classification; Epidemics; Future trends; Laser; Oxygen; Retinopathy of prematurity; Retrolental fibroplasia; Screening guidelines; Vitrectomy.

Figure 1

RetCam fundus images showing retinopathy of prematurity stages 1, 2, 3 and 4A. A: Fundus image of right eye showing stage 1 ROP with demarcation line (black arrows); B: Fundus image of right eye showing stage 2 ROP with ridge (black arrows); C: Fundus image of left eye showing stage 3 extra retinal fibrovascular proliferation (black arrows); D: Fundus picture of left eye showing stage 4A partial retinal detachment not involving the fovea (black arrows). Laser scars are shown with white arrows. ROP: Retinopathy of prematurity.

Figure 2

RetCam fundus images showing retinopathy of prematurity stages 4B, 5, plus disease and aggressive posterior-retinopathy of prematurity. A: Fundus picture of right eye showing stage 4B partial retinal detachment involving the fovea (black arrow). Optic disc is shown with a white arrow; B: Anterior segment picture of right eye showing stage 5 ROP with total retinal detachment (white arrow); C: Fundus picture of right eye showing dilated and tortuous vessels suggestive of plus disease; D: Fundus picture of left eye showing aggressive posterior ROP. ROP: Retinopathy of prematurity.

Figure 3

RetCam fundus images showing threshold, type 1, type 2 retinopathy of prematurity and post laser regressed retinopathy of prematurity. A: Fundus image of right eye showing “threshold ROP” (black arrows); B: Fundus image of right eye showing stage 3 ROP in zone 1 (black arrows) with plus disease suggestive of “type 1 ROP”; C: Fundus image of right eye showing stage 2 ROP in zone 2 (black arrows) without plus disease suggestive of “type 2 ROP”; D: Fundus picture of right eye showing laser scars (black arrows). ROP: Retinopathy of prematurity.