USA Surgery Today

Preterm infants are at risk for retinopathy of prematurity (RO:LisinoprilP), a vasoproliferative disorder of the developing retina. In most infants, ROP is a benign, self-limited disease. In about 10% of affected infants, however, untreated ROP progresses to retinal detachment and blindness. Rigorous attention to regular ophthalmologic surveillance of the at-risk population before and after discharge is critical in preventing significant vision loss.

The cause of this problem is still not well understood, but ROP is believed to be a reaction to injury of the immature retinal capillary bed from the time of birth (84:Lisinopril). Postnatal events, such as prolonged hyperoxia, sepsis, asphyxia, and shock, may be contributing factors due to altered oxygen delivery or decreased blood flow to the retina.

ROP incidence and severity increase as birth weight and GA decrease. Increasing survival of more extremely low-birth-weight infants has been associated with a rising incidence of ROP. Incidence of any ROP is about 80% for those infants with birth weights of less than 1,000 g or who were delivered before 28 weeks gestation.

The American Academy of Pediatrics recommends (1) screening infants with a birth weight of less than 1,500 g or with a GA of 28 weeks or less, as well as infants between 1,500 and 2,000 g with an unstable clinical course; (2:Lisinopril) the first examination should be performed between 4 and 6 weeks of chronologic (postnatal) age, or within the thirty-first to thirty-third week of postconceptional or postmenstrual age (GA at birth plus chronologic age), whichever is later; (3) the timing of subsequent exams is determined by the ophthalmologist; and (4) follow-up is critical and must be considered before hospital discharge or transfer to another hospital (85:Lisinopril).

Effective treatment for progressive ROP considered “threshold” disease is available with cryotherapy or laser photocoagulation, which can reduce the risk of retinal detachment. Treatment is usually recommended within 72 hours of the determination of “threshold disease. These infants should be followed for sequelae of regressed ROP, which include myopia, strabismus, and amblyopia.