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Review
. 2023 Sep 15;10(1):12.
doi: 10.1186/s40348-023-00163-5.

Retinopathy of prematurity: from oxygen management to molecular manipulation

Jonathan Woods  1 , Susmito Biswas  2
Affiliations
Review

Retinopathy of prematurity: from oxygen management to molecular manipulation

Jonathan Woods et al. Mol Cell Pediatr. .

Abstract

Introduction: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the premature retina with the potential to progress to extraretinal neovascularisation. This review serves as an introduction to retinopathy of prematurity (ROP), outlining key parts of ROP pathophysiology, diagnosis and treatment. ROP is traditionally diagnosed by indirect ophthalmoscopy and classified using anatomical zones, stages of disease, and the presence or absence of "plus disease" (dilation and tortuosity of the major retinal arterioles and venules). ROP has a bi-phasic pathophysiology: initial hyperoxia causes reduced retinal vascularisation, followed by pathological vaso-proliferation resulting from subsequent hypoxia and driven by vascular endothelial growth factor (VEGF).

Advancements in management: This review summarises previous trials to establish optimum oxygen exposure levels in newborns and more recently the development of anti-VEGF agents locally delivered to block pathological neovascularisation, which is technically easier to administer and less destructive than laser treatment.

Future directions: There remains an ongoing concern regarding the potential unwanted systemic effects of intravitreally administered anti-VEGF on the overall development of the premature baby. Ongoing dosing studies may lessen these fears by identifying the minimally effective dose required to block extraretinal neovascularisation.

Keywords: Cell proliferation; Infant; Newborn; Ophthalmoscopy; Oxygen; Retinopathy of prematurity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The 2-phase model of ROP. Diagrams shown below the timeline are cartoons of retinal flat mounts, similar to those seen in rat and mouse model
Fig. 2
Fig. 2
Zones of the right eye and appearance of retinal vasculature according to ROP stage. Zone I, the most posterior, is a circular zone centred on the optic nerve and with a radius twice the distance (2x) from the centre of the optic nerve to the centre of the macula (x). Zone II represents a middle zone, concentric to zone I, extending from the border of zone I to the nasal ora serrata (furthest extent of the nasal retina). Zone II is itself subdivided into a posterior zone II, two disc diameters out from the border of zone I, and anterior zone II encompassing the remaining peripheral area of zone II. Zone III is the most peripheral zone extending from the temporal border of zone II and capturing a remaining temporal crescentic area beyond zone II. ROP is likely to be more severe when located in zone I or posterior zone II. Stages 1–3 can occur in any zone of the eye. Here, they are shown in zone II for clarity
See this image and copyright information in PMC

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