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Abstract
Retinopathy of prematurity (ROP) is a potentially blinding disorder of extremely premature infants caused by un-physiologic oxygen supply within the first weeks of life. The disease is characterized by uncontrolled vessel growth at the border of the vascularized zone, in severe cases leading to vitreoretinal tractions and retinal detachment. About 3–5% of all ROP cases need treatment at some point. The use of digital wide-field fundus photography, fluorescein angiography and optical coherence tomography as diagnostic tools generated a wealth of information about early disease features and treatment effects. Currently, intravitreal anti-VEGF injections are considered by many to be the optimal treatment approach for the most severe forms of Type 1 ROP, even though the pharmacological risks in terms of organ development and mortality rate have not yet been fully addressed.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Retinopathy of prematurity (ROP) is caused by altering tissue oxygen concentrations within the first weeks after birth in extremely preterm infants. The optimal oxygen saturation rate is currently unknown.
Major risk factors for the development of ROP are low birth weight, gestational age and artificial ventilation.
Digital wide-angle fundus photography enables telemedicine approaches, in which retina specialists at reading centers can examine images from infants from remote areas.
Fluorescein angiography has become the most sensitive examination method to describe pathologic vessel alterations in ROP, which could not be easily visualized with other methods.
Fluorescein angiography is the ideal method to describe vascular changes following anti-VEGF injections.
Handheld spectral domain optical coherence tomography allows visualization of all retinal layers and description of morphological alterations during the disease process. Cystoid macula edema (CME) and absence of or underdeveloped foveal pit are typical signs of premature retinae.
Intravitreal injections of anti-VEGF molecules has become an important treatment approach, with well over 400 reported infants treated so far since 2008. Most of the time, bevacizumab (Avastin) was the applied drug.
Laser photocoagulation is still the best option for milder forms of treatment-requiring ROP.
Since the anti-VEGF molecules reach the circulation, it is possible that systemic side effects of such a treatment may hamper the physiologic organ development. How these effects could technically be monitored during the infants development needs to be further addressed in the future.