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Retinopathy of prematurity: an epidemic in the making
Graham E Quinn1, Clare Gilbert, Brian A Darlow
1Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA. quinn@email.chop.edu
Insights
Retinopathy of prematurity (ROP) is a growing threat to premature infants
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is an emerging threat to infant vision, particularly in regions with increasing survival rates of premature infants.
- The incidence and prevalence of ROP are influenced by advancements in neonatal care, leading to a larger population of at-risk infants.
Purpose of the Study:
- To comprehensively review the etiology, incidence, and current prevention and treatment strategies for severe retinopathy of prematurity (ROP).
- To highlight the global variations in ROP risk identification and management approaches.
Main Methods:
- A systematic literature review of Medline and PubMed databases using the search term "retinopathy of prematurity and premature birth".
- Discussion of historical perspectives, classification, and treatment modalities for ROP in premature infants.
Main Results:
- Peripheral retinal ablation is effective in preventing blindness in severe ROP cases.
- Preventive measures include improved antenatal/obstetric care, antenatal corticosteroids, optimized neonatal care, and careful oxygen management.
- Sepsis is a risk factor for severe ROP; genetic factors and telemedicine may aid detection.
- Anti-VEGF therapy shows potential but requires cautious use due to unknown long-term effects.
Conclusions:
- ROP is increasingly prevalent due to improved neonatal services, posing a significant risk to premature infants' vision.
- Prioritizing ROP prevention strategies, including reducing preterm birth, enhancing neonatal care, and expanding ophthalmological services, is crucial to combat ROP-related blindness.
Objective:
To explore the etiology, incidence and methods to prevent and treat severe retinopathy of prematurity (ROP), which is rapidly becoming a threat to the vision of babies in areas of the world where increasing numbers of premature babies are surviving.
Data Sources:
The data used in this review were mainly from Medline and PubMed published in English. The search term was "retinopathy of prematurity and premature birth".
Study Selection:
We discuss the historical perspectives, prevalence and incidence, classification and treatment methods of ROP in premature babies.
Results:
Peripheral retinal ablation for eyes with severe ROP can help prevent progression to blindness and several large clinical trials have shown the effectiveness of this treatment in high risk eyes. As a greater proportion of VLBW and ELBW babies survive, the population of babies at risk increases. In various regions of the world, different identification criteria are used to determine which babies are at risk of blindness in order to provide timely diagnostic examinations and treatment as needed. Methods for preventing ROP include better ante-natal and obstetric care leading to a reduction in the rate of prematurity, the use of ante-natal corticosteroids, and better neonatal care practices. Recent developments have indicated that management of oxygen supplementation is important for the prevention of severe ROP; however, there is not yet known what oxygen saturation target should be adopted. Sepsis increases severe ROP in very preterm infants. Genetic associations and a telemedicine approach may be explored to detect ROP. Treatment of anti-VEGF therapy are potentially useful in eyes with severe ROP, but long term effects are not yet known and such treatment should be used with great caution.
Conclusions:
ROP is a potentially binding disease for premature babies which is becoming more prevalent with the development improving neonatal services in many countries in recent years. High priority should be placed on developing approaches to prevent ROP blindness by reducing preterm birth, improving care of premature babies in neonatal care units, and providing adequate ophthalmological services in those regions.
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