pathophysiology of retinopathy of prematurity. rop:risk factors prematurity --- gestational age:...
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Pathophysiology of Retinopathy of Prematurity
Dr. Abhijit Chattopadhyay
Chief Consultant
Dept. of Retina & Uvea
Priyamvada Birla Aravind Eye Hospital, Kolkata
ROP:Risk Factors
Prematurity --- Gestational age: less than 34 weeks
Low Birth Weight: less than 2000 gm especially less than 1250gms
Oxygen therapy : Fluctuating oxygen saturation
Contd…
Other factors : Sepsis, Multiple blood transfusions, Multiple births, Hyaline membrane disease, Use of aminophylline, antibiotics, Apnoeic spells, Low pH
Pathophysiology
At 16 wks-Mesenchyme growth starts as precusrsor of blood vessels
Blood vessels reache Nasal ora by 36 wks and Temporal ora by 40 wks
High O2 obliterate newly formed capillaries, damaging endothelium.
Reduce blood flow due to vasoconstriction
Pathophysiology
Most of the time- no new vessel, normal vasculogenesis-regressed ROP(90%)
Neovascular proliferations- shunt cells break through ILM & grow in vitreous
Pathogenesis
PhaseI: 22 Wk to 30 PM wk. Relative Hyperoxia, decreased VEGF
level.
- Strategy: Prevention and Early treatment
Phase II : 31-44 PM wk Relative hyperoxia, increased VEGF level.
- Strategy: Treatment. Normal O2, normal VEGF, Normal Intra-uterine growth
PhaseI, high 02, low VEGF
Premature birth
Stage 0, Stage1, Stage2 Stage3
Ph2, low 02, high VEGF
StageV
treatment
ETROP Criteria for Treatment
Type I- ZoneI, Any stage,+ - ZoneI, Stage3, No + - Zone II, stage2 or 3, +
Type II- Zone I, Stage1 or 2, No + - Zone II, Stage3, No +
TREAT
OBSERVE Early Treatment of Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity. Arch Ophthalmol 2003;121: 1684-96
FVP
Zone 1 any stage with + Zone II, Stage II +
Zone II, Stage III +
ROP ANIMATION 10-31-03.mpeg
THANK YOU
BABY INFORMATION SHEET
Name of hospitalDate of ph received New baby - Review baby No of baby Follow up Next follow up Procedure
AMRI 7/23/2012 yes 1 ROP SCREENING
AT 9AMRSV 7/23/2012 NIL
AT 9AMB NEOTIA 7/23/2012 YES 4 ROP SCREENING
AT12PMWEST BANK 7/23/2012 NIL
AT 12PMMARTI BHAVAN 7/23/2012 NIL
AT 9AMPARK CLINIC 7/23/2012 NIL
AT 9AMWOOD LANDS 7/23/2012 YES REVIEW 2 ROP SCREENING
AT 8.45AM** *PLEASE CALL TO EACH HOSPITAL ON EVERY MONDAY AND THURS DAY*** OUT SIDE CHECKING DAY- TUES DAY AND FRIDAY
Rop Handout
Chasing dropouts Maintain follow up schedule in Excel worksheet with reminders
ROP Cards updated at every visit with mention of next date of visit
Call parents in case of dropout-- At least 2 phone calls & noted the time & date.-- Registered letter
Call neonatologist
Priyamvada Birla Aravind Eye Hospital (Till 2014 NOVEMBER)
Total baby seen -6750
Rop baby laser: eyes-278
Avastin-30
Rop surgery done-8
StageV, referred- 10
Total StageV, Blind & inoperable= 25
Stage 3 , lasered