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Retinopathy of Prematurity

by Carlo Raj, MD
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    00:01 Our first topic here is a newborn and I don?t mean any newborn, not a term, we have a newborn who's a preemie, so maybe 27 weeks.

    00:10 36 weeks is approximately normal, correct? 27 weeks I?ve given you.

    00:14 Now, the only choice that you have at this point is to then place a beautiful newborn, right, in the NICU, in other words in neonatal ICU.

    00:25 The only choice that you have now in this 27-week-old preemie will then be to provide oxygen.

    00:34 Do you think this newborn that is a preemie at 27 weeks is able to handle all these oxygen that you and I as an adult should be having? I don?t know.

    00:47 Beause there?s every possibility that the oxygen may then become a free radical or reactive oxygen species or reactive oxygen intermediate, whatever you wanna call it.

    00:56 And that free radical, the oxygen therapy, may then cause damage to retina prematurely in which this newborn then goes into blindness.

    01:08 Unfortunate.

    01:09 This is then called retinopathy of prematurity, ROP.

    01:15 Hopefully, the ROP newborn doesn?t go into RIP.

    01:20 A lot of times that happens.

    01:22 You have no choice.

    01:24 You have no choice.

    01:25 You have to give oxygen and then in pathology we?ve talked about how the first 27 weeks there?s every possibility that the newborn may not have surfactant.

    01:34 So in addition there might be neonatal respiratory distress syndrome, correct? In addition, there might be necrotizing enterocolitis, there might bronchodysplasia.

    01:42 So put the entire patient holistically.

    01:46 Make sure that you know what?s going on when there?s free radical damage in the newborn.

    01:50 A bunch of complications that you must know.

    01:52 Now with retinopathy of prematurity, when you?re destroying this retina, the retina then becomes extremely, extremely desperate for blood vessels.

    02:03 So you?re gonna have VEGF-mediated which stands for vascular endothelial growth factor.

    02:10 And you?re gonna have these little blood vessels that are now being formed.

    02:13 It?s called neovascularization.

    02:16 The neovascularization is occurring in this premature newborn.

    02:22 It could be extremely dangerous so therefore, part of the therapy could be the anti-VEGF therapy as well.

    02:29 Keep that in mind, that?s important.

    02:31 Vascular proliferation in retinopathy of prematurity.

    02:34 You?ll have grey avascular retinal border.

    02:38 It?s a newborn who is premature so therefore, the retinal border is not receiving enough blood.

    02:44 This part could actually be normal because it?s a preemie.

    02:49 The neovascularization, as you see here in the schematic, is going to be dilated, tortuous blood vessels.

    02:58 What does that represent? Neovascularization.

    03:01 What happened here? A premature child, maybe 27 weeks, receiving oxygen and in the process may then cause free radical damage.

    03:11 You?ll have a dragged optic disc pulled by the preretinal membrane as I talked about and recurrent retinal bleeding in neovascularization.

    03:23 As all what you?re seeing here depicted in the retina.

    03:25 This is of a newborn.

    03:28 Can you see all those little blood vessels? That?s a lot of neovascularization.

    03:32 All that neovascularization might then be pulling on the retinal layer and in the process you?re worried about retinal detachment.

    03:41 And also this neovascularization or the new blood vessels, they?re extremely, extremely weak and vulnerable to rupture.

    03:50 And if that happens you?ll have retinal bleeding.

    03:52 You see the dark areas in the?it pulls the blood here a little bit?in your fundoscopic examination.

    03:59 All parts of retinopathy of prematurity.


    About the Lecture

    The lecture Retinopathy of Prematurity by Carlo Raj, MD is from the course Retinal Disorders.


    Included Quiz Questions

    1. Oxygen therapy
    2. Intubation
    3. Incubation
    4. Phototherapy
    5. Corticosteroid administration
    1. Cherry red spot
    2. Dragged optic disc
    3. Grey retinal border
    4. Dilated vessels
    5. Neovascularization
    1. VEGF
    2. FGF
    3. CNTF
    4. EGF
    5. GDF-9

    Author of lecture Retinopathy of Prematurity

     Carlo Raj, MD

    Carlo Raj, MD


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