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Retrolental fibroplasia

Retinopathy of prematurity (ROP), also known as retrolental fibroplasia (RLF), is a disease of the eye that affects prematurely born babies. It is thought to be caused by disorganised growth of retinal blood vessels resulting in scarring and retinal detachment. more...

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ROP can be mild and may resolve spontaneously, but may lead to blindness in serious cases. Oxygen toxicity may contribute to the development of ROP.

International Classification of Retinopathy of Prematurity (ICROP)

The system used for described the findings of ROP is entitled, The International Classification of Retinopathy of Prematurity (ICROP). ICROP "demarcated the location of the disease into zones (1, 2, and 3) of the retina, the extent of the disease based on the clock hours (1-12), and the severity of the disease into stages (0-5)" .

Symptoms and prognosis

In preterm infants, the retina is often not fully formed. ROP occurs when abnormal tissue forms between the central and peripheral retina. There are 5 progressive stages to ROP. Stage 1 is mild and may resolve on its own without severe vision loss; stage 5 is severe and usually results in retinal detachment.

Multiple factors can determine how fast a patient progresses through the stages, including overall health, birth weight, the stage of ROP at initial diagnosis, and the presence or absence of "plus" disease. "Plus" disease occurs when the abnormal vessels in the retina invade other areas of the eye, greatly increasing the risk of retinal detachment.

The abnormal vessel growth often subsides spontaneously, but can progress to retinal detachment and vision loss in patients with extremely low birth weight. Patients with ROP are at greater risk for glaucoma, cataracts and myopia later in life, and should be examined yearly to help prevent and treat these conditions.

Treatment

  • Cryotherapy
  • "Indirect laser"
  • scleral buckle and/or vitrectomy may be considered for severe ROP with retinal detachment

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Infant outcomes dismal for PPROM at 18-23 weeks - 15% in Study Survived
From OB/GYN News, 6/15/02 by Sherry Boschert

LOS ANGELES -- Even with advanced neonatal intensive care, few babies born after preterm premature rupture of membranes between 18 and 23 weeks' gestation survived in a study of 101 pregnancies, and most of the survivors struggled with severe health problems, Dr. Usha Verma said at the annual meeting of the Society for Gynecologic Investigation.

Many perinatologists offer expectant management to women with preterm premature rupture of the membranes (PPROM) in the early second trimester in hopes of prolonging gestation, but management of these cases is controversial. How the physician counsels the patient is an important factor. Patients with PPROM in this time period should be told that the babies are likely to die and that "if they survive, almost every one is going to be really sick for a long time," said Dr. Verma of the University of Miami.

The study included all women who presented with PPROM between 18 and 23 weeks' gestation at his institution over a 2-year period; 15% survived.

None of 21 neonates born to mothers who developed PPROM between 18 and 19 weeks' gestation lived. Survival rates were 6% in the 31 neonates born after PPROM at 20-21 weeks and 27% in the 49 babies born after PPROM at 22-23 weeks.

The two babies who survived after PPROM at 20-21 weeks remained in the hospital for 117 and 182 days, respectively Both had chronic lung disease, respiratory distress syndrome, intraventricular hemorrhage, and retrolental fibroplasia. Persistent neurologic deficits remained in one infant.

The 13 infants who survived after PPROM at 22-23 weeks remained in the hospital for a mean of 176 days. Respiratory distress syndrome or chronic lung disease occurred in 10 infants. Four babies had necrotizing enterocolitis. Retrolental fibroplasia or intraventricular hemorrhage occurred in six infants. Eight developed septicemia, and eight underwent surgery for a patent ductus arteriosus.

Giving patients realistic information will help them decide whether to terminate or continue the pregnancy Dr. Verma said.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2002 Gale Group

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