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RETINOPATHY OF PREMATURITY: AN EPIDEMIC IN THE MAKING
Affilliation
University of Pennsylvania. Children’s Hospital of Philadelphia. Philadelphia, Pennsylvania, USA.
International Centre for Eye Health. London School of Hygiene and Tropical Medicine. London, UK.
University of Otago. Department of Paediatrics. Christchurch, New Zealand.
Fundação Oswaldo Cruz. Instituto Fernandes Figuera. Rio de Janeiro, RJ, Brasil.
International Centre for Eye Health. London School of Hygiene and Tropical Medicine. London, UK.
University of Otago. Department of Paediatrics. Christchurch, New Zealand.
Fundação Oswaldo Cruz. Instituto Fernandes Figuera. Rio de Janeiro, RJ, Brasil.
Abstract
Objective
To explore the etiology, incidence and methods to prev
ent and treat severe retinopathy of prematurity (ROP),
which is rapidly becoming a threat to t
he vision of babies in areas of the worl
d 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, prev
alence 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 effect
iveness of this treatment in high risk eyes. As a greater proportion of VLBW and
ELBW babies survive, the population of babi
es 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 pr
ovide timely diagnostic examinations and
treatment as needed. Methods for prevent
iing 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 n
eonatal care practices. Recent developments
have indicated that management
of oxygen supplementation is important for
the prevention of seve
re ROP; however,
there is not yet known what oxygen satu
ration 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 us
eful in eyes with severe ROP, but long term ef
fects are not yet known and such treatment should
be used with great caution.
Conclusions
ROP is a potentially binding dis
ease 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 birt
h, improving care of premat
ure babies in neonatal care
units, and providing adequate ophthalmologic
al services in those regions
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