When do you start to check if the preterm baby has ROP-eg screening for ROP, we have the limit of all babies delivered before 32 weeks or less and 1500 g or less and we start at 6-7 weeks postnatal age.Can we do it from 31 weeks instead, ore even lower??

In our unit we check every premature < 32 weeks GA at the age of 5 -6 weeks.

In the past there have been premature babies of 32 weeks GA with ROP so there is no discussion of lowering the GA for ROP screening.

in a 9 year prospective study of rop in our unit, we noted that all neonates <36 weeks of gestation , irrespective of birthweight should be screened for rop, beginning at 32 weeks of gestaion till term gestation.14 of our babies had birth weight >2000gm and gestation >34 weeks, 30% with a bwt of >1500gms. So our policy is to screen all neonates <36 weeks of gestation.

I think sudershen is right.

You just dont know which preterm baby will go on to develop ROP.

The more preterm the baby is , the more you can delay to start the ROP screening program, but max of 6 weeks. If however you have a baby with GA>28weeks start it early at 4weeks. Once started even if there is no ROP, evaluate every 2 weeks. If there are signs of ROP go for weekly reviews.

We had some very bad ROPs in babies 35 week GA requiring laser therapy.

do you use the Ret Cam to check?

I so wish.

No we use plain old Ophthalmologists with their funny looking headgear. (Hopefully my dear ophthalmology colleagues are not reading this!!!)

Our level III NICU (50 intensive beds and 18 convalescent beds) screens all babies 30 weeks or less and 1500 grams or less per AAP policy statement (Pediatrics, 2006). We begin screening infants born at 27 weeks (GA) or greater at 4 weeks of age. Infants less than 27 weeks receive thier first eye exam at 31 weeks post conception. The infants are then followed every 1-3 weeks depending on the stage ROP found on the previous exam.

Infants who are > 30 weeks or > 1500 grams are screened if the neonatalogist feels the infant is at high risk for developing ROP.

We do about 25 laser treatments every year on infants with severe ROP. That number is growing each year due to the decreasing GA of premature infant survivors. We have had only a few infants who were born at 24 weeks or less who did not develop severe ROP and receive laser.

Reference:

Section of Ophthalmology, American Academy of Pediatrics American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics volume 117, Number 2, February 2006. (An Erratum was published a few months after the policy statement was published decreasing the screening age from 32 to 30 weeks).

We are planning on using the Retinal Camera to document ROP in infants who develop stage III or greater ROP. An RN will be trained to use the camera to take the images. Does anyone use the retinal camera now and if so are RN's using it?

We have had a camera for 8 or 9 years and it takes good images of the eye. Our retinal specialist has used the camera in the past to send images to a Pediatric ophthalmologist for consultation and to document pre & post laser images.

Here is the information on the Camera we use:

Ret Cam. Massie Research Labatories, Inc. 6761 Sierra Court Suite E Dublin, Ca 94568 Phone # 925-560-2465

The only number I could find on the camera is IP 68. I don't know if this is a model number or not. I found the number on the foot pedal of the camera.

Hi,

Can anyone direct me to a recent review article on ROP - state of the art?

Thanks.

Aftab

How about those....

Current understanding and management of retinopathy of prematurity.

http://www.ncbi.nlm.nih.gov/pubmed/17435431

The 'ideal' management of retinopathy of prematurity.

http://www.ncbi.nlm.nih.gov/pubmed/16304583

Evidence-based review of retinopathy of prematurity prevention in VLBW and ELBW infants.

http://www.ncbi.nlm.nih.gov/pubmed/17163000

We use American Academy Of Pediatrics Guidelines as mentioned by Sue Butler.

Regards

Screening Examination of Premature Infants for Retinopathy of Prematurity.pdf

I think the review entitled "Preterm Birth and the Visual System" published in NeoReviews 2005;6;e153-e159( DOI: 10.1542/neo.6-3-e153 ) by Ashima Madan and William V. Good should be read by all to get a holistic idea of what all is going on and what all can go wrong in a preterm's vision

hi, some one have any experience with triamcynolone to treat ROP?

hi, some one have any experience with triamcynolone to treat ROP?

Intravitreous triamcinolone is still in early stages of evaluation for its efficacy in ROP.

You may find the following articles informative

Hartnett ME, Martiniuk DJ, Saito Y, Geisen P, Peterson LJ, McColm JR.

Triamcinolone reduces neovascularization, capillary density and IGF-1 receptor phosphorylation in a model of oxygen-induced retinopathy.

Invest Ophthalmol Vis Sci. 2006 Nov;47(11):4975-82.

LINK 1 (Free)

Spandau UH, Sauder G, Schubert U, Hammes HP, Jonas JB.

Effect of triamcinolone acetonide on proliferation of retinal endothelial cells in vitro and in vivo.

Br J Ophthalmol. 2005 Jun;89(6):745-7

LINK 2 (Free)

Akkoyun I, Yilmaz G, Oto S, Kahraman B, Haberal N, Akova YA.

Impact of triamcinolone acetonide on retinal endothelial cells in a retinopathy of prematurity mouse model.

Acta Ophthalmol Scand. 2007 Nov;85(7):791-4

LINK

Lakhanpal RR, Fortun JA, Chan-Kai B, Holz ER.

Lensectomy and vitrectomy with and without intravitreal triamcinolone acetonide for vascularly active stage 5 retinal detachments in retinopathy of prematurity.

Retina. 2006 Sep;26(7):736-40.

LINK

Edited September 15, 200816 yr by JACK

thanks

Jn 2009 issue of curosurf newsletter "curoservice.com .newsletter" slide section,has an update by Rangaswamy Rmanathan on ROP "Third epidemic of Retinopathy of prematurity, a neonatologist,s vision". I feel it should be read by all neonatolgist,s , he emphasized tha hyperoxia at birth may be one important the cause of rop and delivery rooms should have o2 aor bleners for resuscitation, which most delivery rooms to my knoledge in devloping countries do not have.

We have a 56 bed, level III-IV NICU. Our hospital delivered approx. 7000 babies last year with about 1000 admits to the NICU. We also use the American Academy Of Pediatrics Guidelines that Sue Butler and Dr.Mehrem mentioned. Babies less than or equal to 30 weeks or less than or equal to 1500 grams receive an exam for ROP. We also use the time frame of 27 weeks and above are screened at 4 weeks and less that 27 weeks when they are 31 weeks postconceptional age. We instituted an 02 targeting program about 2 yrs. ago which shows promise of reducing our number of laser surgeries.

do you have a guideline to lasser treatment in NICU? about sedation, turn off the lights, etc.

do you have any experience about intravitreal avastin for ROP?

do you have any experience about the use of intravitreal injection of bevacizumab to treat ROP?