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Natural history of retinopathy of prematurity: a prospective study
A R Fielder1, D E Shaw, J Robinson
1University of Leicester Medical School.
Insights
Retinopathy of prematurity (ROP) affects over half of premature infants, with severity linked to lower birthweight. Most cases resolve, but some lead to lasting vision issues, impacting screening strategies.
Area of Science:
- Ophthalmology
- Neonatology
- Developmental Biology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Understanding the natural history and risk factors for ROP is crucial for effective management and screening.
Purpose of the Study:
- To prospectively investigate the natural history of retinopathy of prematurity in low birthweight infants.
- To identify subtle features, incidence, severity, and progression patterns of ROP.
- To evaluate the relationship between ROP and factors like birthweight, gestational age, and postnatal development.
Main Methods:
- Prospective study of 572 infants with birthweight ≤ 1,700 g.
- Utilized a specific protocol to observe subtle ROP features.
- Monitored infants for ROP development, stages, resolution, and sequelae.
Main Results:
- Acute ROP developed in 50.9% of infants.
- Stages 1 and 2 ROP resolved completely; 4.7% with stage 3/4 developed cicatricial sequelae.
- ROP incidence and severity correlated inversely with birthweight and gestational age.
- ROP onset showed a predilection for the nasal retina in the most immature neonates.
- Retinal arteriolar tortuosity appeared around three months postnatally, linked to ROP severity.
Conclusions:
- ROP's natural history is influenced by developmental stage, birthweight, and gestational age.
- Specific retinal regions (nasal) and timing of onset are key indicators.
- Findings have implications for optimizing ROP screening protocols in premature infants.
Abstract:
The natural history of retinopathy of prematurity (ROP) has been studied prospectively in 572 infants < or = 1,700 g birthweight using a protocol designed specifically to investigate the subtle features of this condition. Acute ROP developed in 50.9%. All ROP stages 1 and 2 underwent complete resolution and of the 27 (4.7%) infants with stage 3/4 disease, cicatricial sequelae developed in six. Incidence and severity increased with decreasing birthweight and gestational age. Onset was not confined to the temporal retina but exhibited a predilection to start first in the nasal retina of the most immature neonate. The vertical retinal regions were relatively spared. Retinal arteriolar tortuosity developed around three months postnatally and was related to ROP severity but not its presence. The age at onset and rate of progression of retinopathy were largely determined by the stage of development but were also modified by systemic and local factors. The relevance of these findings to ROP screening is discussed.