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What is retinopathy of prematurity?
Underneath the retina is a network
of blood vessels. These blood vessels
normally grow quickly in the last
few weeks before a baby is born.
If the baby is born prematurely,
there can be a problem with this
growth.
In some premature babies, the blood
vessels grow into parts of the eye
where they do not belong. This can
cause scar tissue to form inside
the eye. The scar tissue can damage
the retina and cause a significant
loss of vision. This condition is
called retinopathy of prematurity.
Why do babies get retinopathy of prematurity?
Most infants who are born about
2 months or more prematurely or
have a low weight at birth will
have some amount of retinopathy
of prematurity. Fortunately, the
condition is often not severe, will
not harm vision, and will go away
without needing treatment. In some
infants, however, the retinopathy
of prematurity will develop very
quickly and could cause a loss of
vision or even blindness.
Over the years, doctors have identified
several things that seem to make
retinopathy of prematurity worse,
such as supplying too much oxygen
to premature babies. Avoiding those
things has reduced the number of
babies with severe retinopathy of
prematurity, but it has not eliminated
the condition.
There is no way to predict which
babies will develop the more severe
forms of retinopathy of prematurity.
This is why it is very important
for all babies born at 28 weeks
or earlier, who weigh less than
1,500 grams (about 3 pounds, 5 ounces)
at birth, or whose neonatologist
deems them to be a high risk to
be examined by an eye doctor. This
exam often takes places 4 to 6 weeks
after birth.
How does the doctor know whether an infant has retinopathy of prematurity?
The doctor will use a special instrument
to look inside the eye at the retina.
An important part of this examination
is to find out how much of the retina
of each eye may be affected by retinopathy
of prematurity.The doctor will grade
the results of the examination on
a standard scale of five stages.
Stage 1 retinopathy of prematurity
is the least severe form of the
condition, and stage 5 is the most
severe.
How is retinopathy of prematurity treated?
Only a doctor can recommend the
right treatment for a baby with
retinopathy of prematurity. The
recommended treatment will depend
on how severe the retinopathy is.
Stage 1 or 2 retinopathy usually
does not require any treatment.
Instead, the doctor will probably
schedule frequent eye examinations
to make sure that the baby's condition
does not get worse. It is very important
to keep these appointments, because
the abnormal blood vessels could
start growing at any time.
The doctor might recommend treatment
for higher stages of retinopathy
of prematurity. The only available
treatments are surgical, and they
are done under general anesthesia
- that is, with the infant "asleep."
The procedures to treat retinopathy
of prematurity include:
- Laser photocoagulation.
This procedure is used to stop
the abnormal growth of blood
vessels through the retina.
The surgeon focuses a laser
beam onto a small spot on the
retina where blood vessels are
growing. The laser beam heats
up that spot, creating a tiny
burn in the blood vessels and
stopping their growth. In most
cases, the abnormal blood vessels
will then get smaller and disappear.
- Cryoretinopexy. This procedure
is also used to stop the growth
of blood vessels. But in this
treatment, an instrument called
a cryoprobe is placed on the
outside of the eye. The tip
of this instrument gets very
cold - so cold that it freezes
the abnormal blood vessels growing
inside the eye. This will also
stop the growth of blood vessels
and make them shrink away.
- Scleral buckling. The abnormal
blood vessels and scar tissue
damage the retina by pulling
it away from the inside surface
of the eyeball. This is called
a retinal detachment, and it
can cause a significant loss
of vision. One way to reduce
the tension on the retina is
to push the wall of the eyeball
inward. This can be done using
something that looks like a
rubber band. This elastic band
is placed around the eyeball,
and it pushes the inside surface
of the eye up against the retina.
This is called scleral buckling.
The elastic band is removed
when the eye outgrows it or
when the retina becomes reattached
to the inside surface of the
eye.
- Vitrectomy. In eyes with
a large amount of scar tissue
and blood vessels, the surgeon
might have to remove some of
the gel-like fluid called vitreous.
The surgeon will also remove
the scar tissue that is pulling
on the retina. This should help
reduce the chances of a retinal
detachment and prevent the loss
of vision.
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