Retinopathy of prematuriry – modern guidelines, diagnosis and treatment
DOI:
https://doi.org/10.13112/pc.1064Keywords:
RETINOPATHY OF PREMATURITY; LIGHT COAGULATION; VASCULAR ENDOTHELIAL GROWTH FACTORS; HYPOXIA; MYOPIAAbstract
Retinopathy of prematurity (ROP) is a frequent cause of childhood blindness in developed countries, despite current treatment options, and is also increasingly observed in the developing world. ROP progresses in two phases. The first phase starts with delayed retinal vascular development after birth and partial regression of existing blood vessels, followed by a second phase in which hypoxia leads to pathological vessel proliferation. Two major risk factors for ROP are the use of supplemental oxygen and reduced gestational age. Hyperoxygenation influences ROP through the regulation of vascular endothelial growth factor (VEGF). High oxygen concentrations suppress VEGF production in the initial stage of ROP, preventing normal blood vessel growth, whereas elevated VEGF levels during the subsequent hypoxic phase stimulate abnormal neovascularization. Insulin-like growth factor I (IGF-1) is considered the most significant oxygen-independent risk factor for ROP. The CRYO ROP and ETROP studies confirm the efficacy of cryotherapy and laser photocoagulation in children with ROP, with laser photocoagulation being the treatment of choice. Surgical intervention is reserved for later stages of the disease but has limited functional outcomes. Because of the risk of complications, children with this condition require prolonged follow-up.
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