Treatment of stage 1 retinopathy of prematurity

Premature babies are not as healthy as full-term babies. Because of premature birth, they are likely to develop some diseases. Even in an incubator, there is no guarantee that they will develop some diseases, and it is very difficult for them to survive. Therefore, when a premature baby is born, he or she must be examined immediately to detect retinal disease as early as possible and then receive treatment. In this way, the disease will not be delayed for too long. Let us now learn about the treatments for this disease.

1. Surgery

(1) Cryotherapy: Continuous cryotherapy of the avascular zone in the retina surrounding the threshold ROP can prevent 50% of cases from developing serious consequences that affect vision, such as macular wrinkles, posterior retinal detachment, and retrolental fibroplasia. Cryotherapy is usually performed under local anesthesia, but can also be performed under general anesthesia. General anesthesia may cause bradycardia, apnea, cyanosis, etc. Complications of condensation include conjunctival edema, bleeding, tearing, vitreous hemorrhage, central retinal artery occlusion, retinal hemorrhage, etc. Currently, the short-term efficacy of ROP cryotherapy has been confirmed, but the long-term efficacy remains to be further determined.

(2) Laser photocoagulation therapy: In recent years, with the advent of indirect ophthalmoscope output laser devices, photocoagulation therapy has achieved good results in the treatment of ROP. Compared with cryotherapy, photocoagulation is more effective for zone I ROP and has similar efficacy for zone II lesions. It is more precise in operation and can reduce vitreous hemorrhage, postoperative conjunctival edema, and intraocular inflammation. It is currently believed that photocoagulation is the preferred treatment for threshold ROP. Diode laser treatment is widely advocated abroad. Diode laser is red light or infrared light, has strong penetrating power, is not easily absorbed by the refractive medium, and has few complications. Some authors have also tried to use transscleral 810nm laser instead of cryotherapy, which significantly reduced complications.

(3) Scleral cerclage: If the threshold ROP is not controlled and develops to stage IV or stage V ROP where the fundus can still be seen clearly, scleral cerclage may achieve good results. The purpose of scleral entanglement in the treatment of ROP is to relieve retinal traction, promote subretinal fluid absorption and retinal reattachment, and prevent the disease from progressing to stage V. However, some scholars believe that some children can still recover on their own without surgery.

(4) Vitrectomy: For patients with failed scleral circumcision and stage V, only complex vitrectomy can be performed. The surgical effect is best when the retinal detachment is wide funnel-shaped, with about 40% of the retina being able to be reattached, while the surgical effect is worst when the retinal detachment is narrow funnel-shaped, with only 20%. After vitrectomy, the retina is partially or completely repositioned anatomically, but the child's final visual function recovery is extremely limited, and useful vision is rarely restored.

2. Medical treatment

(1) Oxygen therapy for pre-threshold ROP: Since oxygen therapy can induce the occurrence of ROP, there was a period of time when oxygen therapy was prohibited for premature infants. However, this is not a fundamental solution and it also increases the mortality rate of premature infants. With the establishment of the role of vascular growth factor in the formation of ROP, it was found that hypoxia can induce the synthesis of vascular growth factor. Oxygen supplementation therapy was proposed to inhibit the growth of new blood vessels and inhibit the occurrence and development of ROP, but further research is needed.

(2) Angiogenesis inhibitors: still under development and animal testing.

This article tells us what the treatment is for stage 1 retinopathy of prematurity. The most important treatment method is still surgery, but premature babies are too weak, so they must first supplement their nutrition to enhance their physical fitness before they can receive treatment.