What is retinopathy of prematurity screening?

Once retinopathy of prematurity occurs, it will progress very quickly and eventually seriously affect the child's health. Most cases of retinopathy of prematurity occur in premature infants. At this time, we need effective retinopathy of prematurity screening. For this situation, prevention is the priority. The probability of disease is not very high, but parents should also be vigilant. So what is the screening for retinopathy of prematurity like?

1. Screening methods for ROP

Premature infants should begin regular fundus examinations 2 weeks after birth or at 32 weeks of corrected gestational age. One hour before the examination, 5 g/L tropicamide and 5 g/L phenylephrine hydrochloride eye drops (Medo-Rite) were applied to both eyes of the child, 1 drop/time, once every 15 minutes, for a total of 2 times. After the pupil is fully dilated, 5 g/L proparacaine hydrochloride (Alcain) is used for topical anesthesia and then the patient is examined in a dark room. Premature infants were placed in the supine position with their eyelids opened using a pediatric eyelid speculum. A detailed retinal examination was performed using the RetCam II [1] system, starting with the right eye and then the left eye, with the optic disc at the pole, followed by the macula, then the posterior temporal, superior, nasal, and inferior sides. Retinal photographs were taken and retinal lesions were classified into stages 1 to 5 according to the 1984 international standard (ICROP). ROP cases were examined once a week using the same method until the corrected gestational age was 44 weeks, and then examined once a month for half a year. Cases above stage 3 were treated with laser or surgery as early as possible. Those without ROP were examined once a week until the corrected gestational age was 44 weeks.

II. Treatment

Once the disease occurs, it progresses rapidly and the time window for effective treatment is very narrow. Therefore, premature infants under 37 weeks of gestation should be examined promptly after birth, and those at high risk should be examined weekly. Laser or cryotherapy can be performed in stages 2 to 3 to coagulate the avascular area. In stages 4 and 5, vitrectomy is performed to remove the proliferative fibrovascular tissue and photocoagulation is performed at the same time to save vision.

Prognosis

The prognosis of vision for retinopathy of prematurity varies with the severity of the disease during the active phase and the extent of the remaining fibrous membrane. Those who can stop the disease on their own during the 1st or 2nd stage of the active phase will not have much damage to their vision. Those who have residual fibrous membrane but have not affected the macula can also retain good vision. When the fiber membrane is formed to 4 to 5 degrees, the vision is extremely poor.

4. Prevention

Strictly limiting the use of oxygen for premature infants is the only effective preventive measure. Unless cyanosis is life-threatening, 40% oxygen concentration can be given, and the time should not be too long. In addition, the early use of large doses of vitamins may also have a certain preventive effect. Early detection and timely application of cryotherapy or laser photocoagulation have been reported to successfully prevent further deterioration of the lesions.

In order to prevent the occurrence of secondary glaucoma, in active and severe cases, mydriasis must be given frequently to avoid posterior synechiae. The appropriate mydriatic agent is 2% atropine, which can avoid atropine poisoning and prevent anterior adhesion of the iris peripheral part due to long-term continuous pupil dilation.

There are many types of retinopathy of prematurity. We need to prevent secondary glaucoma in retinopathy of prematurity and other different conditions. Sometimes they come together, which is not good for our children's vision. We prevent it in advance to avoid causing pain to the children, so as to ensure the health of the children!