Eye Screening for Premature Babies

Retinopathy of prematurity (ROP) is a potentially avoidable cause of irreversible, and usually total blindness in infants who are born premature. This occurred because all preterm infants were given 100% oxygen whether they needed it or not. Oxygen is highly toxic to blood vessels, including those in the retina. Blindness from ROP can be controlled by –·        

• reducing the incidence through excellent neonatal care·        
• detecting and treating infants who develop the severe stages of disease

Infants with ROP have a massively increased risk of other pathology: high degrees of myopia; squint; cortical brain damage. They require long term regular follow up so these problems can be detected and managed.

 1. A 9 weeks male baby born in 33 weeks of gestation weighing 1130 gms was seen on 23.04.2020 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed presence of ROP in both eyes in stage 2 in zone 1 in both eyes with no plus disease. The baby was advised for close follow up. In 10^th week the baby was advised of advised of laser intervention to both eyes at the earliest as fundus photos showed plus disease in both eyes. The baby underwent laser treatment on 05.05.2020.

 2. A 3 months old female baby with sepsis, low birth weight born in 7^th month with 1.2 kgs was seen on 04.03.2020 by Dr.Krishna R Murthy. The baby’s parents gave a history of surgery of left hip arthrotomy on 19/12/2019. Eye fundus photos of the baby showed presence of ROP in both eyes in stage 4; left eye worse than right eye. The baby was advised for Vitrectomy surgery to left eye to attach the retina. The baby underwent Vitrectomy surgery on 08.05.2020.      

As the baby was 3 months old, it required ICU backup + neonatal care services post surgery. After completion of surgery the baby was shifted to other hospital which was equipped with ICU & neonatal care services.

Plan of treatment

The surgery lasted for 2 hrs 30 min & was uneventful. Post surgery, the baby was shifted to ICU equipped hospital with a round the clock nursing staff and neonatologist. The baby was in intensive care unit & monitored for 1 day & was discharged with an advice for compliance to follow-up. As on 12.05.2020 the baby is doing well.

Retinopathy of prematurity (ROP) is related to oxygen-regulated vascular endothelial growth factor and to insulin-like growth factor. The natural course of ROP leads to blindness, causing a social and financial burden on the community. Irreversibly impaired vision may also hinder cognitive and psychomotor development of the affected children.

ROP may be prevented by providing health care for the infant during their stay in the Neonatal Intensive Care Unit (NICU). Oxygen-therapy may be potentially toxic to several organs and tissues, including the still immature retina. Preterm infants are more prone to the effects of oxygen toxicity, since they were used to low oxygen tensions during intrauterine life. After premature birth, there is a dramatic increase in oxygen concentration, which may lead to sustained hyperoxia that may overproduce vascular endothelial growth factor (VEGF). High levels of VEGF stimulate neovascularization of the retina, which in severe cases may result in retinal fibrosis and retinal detachment

Screening programs to detect ROP, including systematic fundus examinations at NICU in infants at risk for ROP, provide the best possibility of diagnosing the disease in order to establish an appropriate treatment prior to progression to more advanced stages and blindness.

1. A 3 weeks male baby born in 36 weeks of gestation weighing 800 gms was seen on 10.01.2020 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed aggressive posterior Retinopathy of Prematurity with fovea not yet vascularized (fovea is a tiny pit located in the macula of the retina that provides the clearest vision of all and is aligned with the central axis of the lens). The baby was advised of antivegf injection to both eyes at the earliest. The baby was administered injection on 14.01.2020. As on 14.02.2020; vascularisation still in zone 1 and has been advised for close observation.

1. A 6 weeks female baby born in 28 weeks of gestation weighing 1120 gms was seen on 05.12.2019 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed presence of ROP in both eyes in stage 2 in zone 2 in both eyes. The baby was advised of laser intervention to both eyes. The baby underwent laser treatment on 09.12.2019. As on 03.02.2020 the baby is doing well; ROP has regressed in both eyes

The eye works as a camera. The front of the eye has the lens, which focuses on an image, and the pupil, works like a camera shutter to control how much light enters the eye. At the back of the eye is the retina: Like film in the camera, this layer of nerve tissue is necessary to record the information that’s coming in and allow the brain to “develop” it into an image. When babies are born early, the blood vessels that feed the retina usually haven’t finished growing. In ROP, blood vessels swell and overgrow in the light-sensitive layer of nerves in the retina at the back of the eye. These vessels actually stop growing for a time, and then begin growing abnormally and randomly. The new vessels are fragile and can leak, leaving the retina scarred. In the worst-case scenario, the retina detaches (tears away from the back wall of the eye) and puts the baby at high risk of becoming blind. 

1. A 7 weeks male baby born in 27 weeks of gestation weighing 960 gms was seen on 16.10.2019 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed absence of ROP. The baby was reviewed on 30.10.2019 eye fundus pictures of the baby showed presence of ROP in both eyes in stage 2 in zone 2 (The zone indicates where the disease is located & Zone 2 covers the middle of the retina) with plus disease. The baby was advised of laser intervention to both eyes (Laser therapy burns away the area around the edge of the retina, which has no normal blood vessels). The baby underwent laser treatment on 07.11.2019. As on 20.11.2019 the baby is doing well; ROP has regressed.

1. An 8 weeks male baby born in 28 weeks of gestation weighing 1600 gms was seen on 04.11.2019 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed presence of ROP in both eyes in stage 2 in zone 2 in right eye and in left eye ROP in stage 3 with pre retinal haemorrhage (Neovascularization extends from the ridge into the vitreous). The baby was advised of laser intervention to both eyes. The baby underwent laser treatment on 04.11.2019. As on 20.11.2019 the baby is doing well; ROP has regressed; left eye vitreous haemorrhage is resolving.

ROP is a disorder of development of retinal blood vessels in premature babies. Normal retinal vascularization happens centrifugally from optic disc to ora. Vascularization up to nasal ora is completed by 8 months (36 weeks) and temporal ora by 10months (39–41 weeks).The incidence of ROP is increasing in India because of improved neonatal survival rate. The crucial risk factors are – birth weight, gestational age and oxygen therapy. There is need to increase the awareness of the disease to make sure these babies can be treated on time.

1. A 5 weeks female baby born in 27 weeks of gestation weighing 1000 gms was seen on 27.05.2019 by Dr.Krishna R Murthy. Eye fundus photos of the baby showed absence of ROP. The baby was reviewed on 10.06.2019 eye fundus pictures of the baby showed presence of ROP in both eyes in stage 2 in zone 2 with plus disease. The baby was advised of laser intervention to both eyes. Since the stimulus for abnormal vessels comes from the avascular retina therefore ablating the peripheral avascular retina is believed to cause regression of the ROP. The baby underwent laser treatment on 26.06.2019. As on 14.08.2019 the baby is doing well; ROP has regressed.

 2. A 2 weeks female baby born in 29 weeks of gestation weighing 1020 gms was seen on 17.07.2019 by Dr.Krishna R Murthy. Eye fundus pictures showed absence of ROP. When the baby was reviewed on 24.07.2019 eye fundus pictures of the baby showed presence of ROP in both eyes in stage 1 in zone 2 with early plus disease. Close observation of the baby was advised. When the baby was reviewed on 31.07.2019; ROP had progressed to stage 2 in zone 2. The baby was advised of laser intervention to both eyes. The baby underwent laser treatment on 03.08.2019. As on 21.08.2019 the baby is doing well; ROP has regressed.

Retinopathy of prematurity (ROP) is a potentially avoidable cause of irreversible, and usually total blindness in infants who are born premature. It is a major cause of blindness in children and has lifelong implications for the child. This occurs because all preterm infants were given 100% oxygen whether they needed it or not. Oxygen is highly toxic to blood vessels, including those in the retina. Infants with ROP have a massively increased risk of other pathology like high degrees of myopia; squint; cortical brain damage. They need regular follow up so these problems can be detected and managed.

1. A 5 weeks female baby born in 27 weeks of gestation weighing 920 gms was reviewed on 21.02.2019 by Dr.Krishna R Murthy.  The baby was at high risk of APROP. Aggressive posterior retinopathy of prematurity (AP-ROP) is a severe and rare form of ROP which is characterized by fast progression to an advanced stage. The baby was advised for antivegf injection to both eyes at the earliest. Anti-VEGF drugs work by blocking the overgrowth of blood vessels in the retina.  The baby underwent both eyes antivegf injection on 23.02.2019 followed by laser treatment. As on 09.05.2019 ROP has regressed in both eyes and the baby has been advised to review after 2 weeks.

1. A 7 weeks male baby born in 28 weeks of gestation weighing 1000 gms was reviewed on 25.03.2019 on follow-up for detection of ROP. The baby was diagnosed to have both eyes ROP in stage 2 in zone 2 (zone means part of the retina affected, a) central b) peripheral & c) outer part of retina) with plus disease. The baby was advised for laser intervention to both eyes to avascular retina.  The baby underwent both eyes laser treatment on 27.03.2019. As on 08.04.2019 ROP has regressed in both eyes and the baby is doing well.