Retinopathy of prematurity- true is –
Question Category:
Correct Answer:
Most cases resolve spontaneously
Description:
Ans. is 'b' i.e., Most cases resolve spontaneouslyo Retinopathy of prematurity (ROP) is a disease that affects immature retinal vasculature of premature babies. The retinal manifestations of this disease are noted some weeks after birth in premature infants who have been given high concentration of O2 and is usually confined to those with a birth weight of under 1.5 kg and/or a gestational age of 32 weeks. ROM can be mild with no visual defects or it may become aggressive with neovascularization and progress to retinal detachment and blindness. All babies weighing less than 1500 gm at birth or having a gestation period of less than 32 weeks should be screened with indirect ophthalmoscopy for ROM, between 32 and 36 weeks post conceptiono Important risk factors for ROM are: -# Primary: - Prematurity: Gestation age < 32 weeks (most important); Birth weight <1.5 kg; Oxygen therapy: Excessie oxygen use.# Other:- Sepsis, multiple blood transfusions, apnoeic spells, metabolic acidosis, use of aminophylline & antibioticso Important signs of ROM are: - i) Leukocoria (white pupil); ii) Nystagmus (abnormal eye movements); iii) Strabismus (crossed eye); iv) Severe nearsightedness (myopia).Classification of ROP:o ROP is described using a number of parameters. These are location of the disease into zones (1, 2, and 3), the circumferential extent of the disease based on the clock hours (1-12), the severity of the disease (stage 1-5) and the presence or absence of "Plus disease".1) Classification on the basis of severity, ROP is divided into 5 stages# Stage I - the first sign of ROP (stage 1) is the appearance of a thin, fiat, white structure (termed a demarcation line) at the junction of vascularized retina posteriorly and avascular retina anteriorly.# Stage II - the demarcation line develops into a pink or white elevation (ridge) of thickened tissue.# Stage III - proliferation of vessels over the ridge and into vitreous (extravitreal fibrovascular proliferation).# Stage IV - partial retinal detachmentIVa - partial detachment with macular sparingIVb - partial detachment with macula involved# Stage V - total retinal detachment2) Classification on basis of anatomical location# Since there is a direct correlation between severity of disease and amount of avascular retina, the location of the border between vascularized and avascular retina is an important prognostic sign.# 3 zones are divided to describe the location of ROP. Location of the border in zone 1 is the most severe disease and in zone 3 least.i) Zone 1 is defined as a circle, the center of which is the disc, and the radius of which is twice the distance of the disc to the fovea.ii) Zone 2 is a doughnut-shaped region that extends from the anterior border of zone 1 to within one disc- diameter of the ora serrata nasally and to the anatomic equator temporally.iii) Zone 3 encompasses the residual temporal retina.o Plus disease As ROP progresses, more and more shunting occurs in the neovascular tissue at the retinal vascular- avascular junction. This increased retinal vascular blood flow results in dilation and tortuosity of the major retinal arteries and veins in the posterior pole - described as "plus disease". Plus disease is the hallmark of rapidly progressive ROP and is notated by adding a plus sign after the number of the ROP stage.Management:-Most of the cases (approx. 80%) of ROP resolve spontaneously, hence intervention is chosen according to the below given protocol. ROP is divided into threshold and prethreshold disease.o Threshold disease : It is defined as stage 3+ ROP in zones 1 or 2 occupying at least five contiguous clock-hours or eight noncontiguous clock-hours of retina. Treatment of threshold disease is - Laser photocoagulation.o Prethreshold disease is divided into 2 types :High risk or Type I - treatment is Laser photocoagulationLow risk or Type II - treatment is Weekly or twice weekly observation
Get More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now