Retinopathy of prematurity treatment: Asian perspectives

Abstract

Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.

Fig. 1

Wide-field digital ROP screening by Retcam imaging

Fig. 2

a Indirect ophthalmoscopic examination with scleral indentation for ROP screening under topical anaesthesia. b Photoablation by laser indirect ophthalmoscopy using 532 nm green laser also under topical anaesthesia

Fig. 3

a Left eye with circumferential Stage 4A ROP in Zone 1. b Left eye 4 weeks after 25G LSV showing regressed ROP