Retinopathy of prematurity: Causes, prevention and treatment
Advances in neonatal intensive care have improved survival rates in extremely premature infants, which has led to an increase of retinopathy of prematurity (ROP) in the developed world. Left untreated, infants are at risk of developing strabismus, myopia, vitreous haemorrhage, vitreo-retinal fibrosis, retinal detachment, secondary angle closure glaucoma and, ultimately, complete loss of vision. The improvements in the understanding and treatment of ROP have been supported by seminal research, and its complexity is still being explored. However, the importance of early screening and treatment is essential in the prevention and management of this disease. This paper examines the causes and treatments of ROP, as well as implications for future neonatal practice.
Retinopathy of prematurity (ROP) is a proliferative disorder of the immature retinal vasculature. The retina has no blood vessels until around 16 weeks' gestation; the vessels grow out from the optic disc and only reach the periphery of the eye 1 month after birth (Kanski, 2011). ROP was recognised in 1942 in Boston, USA, by Theodore L Terry, and was initially named retrolental fibroplasia. It was described as a ‘fibroplastic overgrowth of persistent vascular sheath behind each crystalline lens’ (Fleck and McIntosh, 2008: 84). While Terry identified ‘fibroblastic overgrowth’, he did not identify the specific aetiological connection to oxygen. Further research, undertaken by Dr Patz in the 1950s in Washington DC, showed that premature infants now cared for in closed cots/incubators, who received high concentrations of oxygen in a confined space, were more likely to develop ROP than those who received low levels. This discovery resulted in oxygen levels administered to preterm infants being restricted to a maximum of 40%, which resulted in increased levels of morbidity and mortality. Thus, the importance of adequate oxygenation with careful monitoring of blood gas measurement and saturation monitoring was seen as the way forward in preventing ROP.
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