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[Retinopathy in premature infants]
1Neonatalafdeling GN 5024, Rigshopitalet, København.
Insights
Retinopathy of prematurity (ROP) is a serious complication for premature infants. Early screening and cryotherapy can prevent vision loss, but effective drug prevention remains elusive.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
Context:
- Retinopathy of prematurity (ROP) is a significant complication affecting very preterm infants.
- High incidence in Denmark due to increased survival rates of preterm infants.
- ROP poses a risk of permanent vision loss.
Purpose:
- To review the current understanding and management of retinopathy of prematurity.
- To highlight the challenges in preventing ROP and its visual consequences.
Summary:
- Free radical injury is implicated, but oxygen reduction's efficacy is uncertain, especially with hypoxia risk in vulnerable infants.
- Reducing light exposure may mitigate risk.
- Vitamin E is not proven effective; cryotherapy for threshold ROP (stage 3+) reduces vision loss risk from 50% to 25%.
Impact:
- Effective ROP screening is crucial in neonatology.
- Diagnosis and cryotherapy demand specialized skills and experience.
- Early intervention with cryotherapy significantly improves visual outcomes.
Abstract:
Retinopathy of prematurity (ROP) is a complication of very preterm birth. The problem is relatively common in Denmark; although only 10 infants are blinded each year, this represents a high incidence in international comparison. The very complete Danish registry of the blind may be partly responsible. The incidence remains high due to the increased survival rate in very preterm infants. Although free oxygen radical injury most likely plays a central role, it is doubtful if reduction of supplementary oxygen under careful monitoring can reduce the risk of ROP. Unfortunately, the most preterm and most unstable infants, who are at highest risk of ROP, are also particularly exposed to hypoxia. It is possible that light increases the risk, even for other reasons it is recommended to reduce the intensity of light in the ward or to use eye pads, at least some of the time. There is no effective drug prevention, in particular there is no evidence that vitamin E is useful. Cryotherapy, however, in the acute phase of threshold disease (stage 3+), can reduce the risk of permanent loss of central vision from about 50% to 25%. Effective screening for ROP has become part of modern neonatology. Diagnosis as well as cryotherapy requires particular skill and experience.