Education  India Project #19979

Eye Screening for Premature Babies

by Vittala International Institute of Ophthalmology
Eye Screening for Premature Babies
9 weeks old female baby treated for ROP
9 weeks old female baby treated for ROP

ROP is a problem with the way the blood vessels develop on the surface of the retina. When a baby is born prematurely these blood vessels are immature like the rest of the baby. In most premature babies the retinal blood vessels grow properly. In some premature infants the blood vessels start to grow the wrong way. Instead of branching like a tree the vessels link up side to side and in some cases grow away from the retina towards the centre of the eye. The severity of ROP is graded from stage one to stage five. Stage one is the mildest and stage five the most severe.

1. A 9 weeks female baby born in 31 weeks of gestation weighing 900 gms was reviewed on 26.11.2018 by Dr.Krishna R Murthy. The baby was diagnosed to have ROP Retinopathy of Prematurity (ROP) in stage 2 in zone 2 with early plus disease. The baby was advised for laser intervention to both eyes to avascular retina at the earliest. The baby underwent both eyes laser treatment on 01.12.2018. As on 14.01.2019 ROP has regressed in both eyes and the baby has been advised to review after 6 months with an Ophthalmologist locally.

 

 2. A 4 weeks female baby born in 28 weeks of gestation weighing 118 gms was on close follow-up for detection of ROP. The baby was administered antivegf injection when the baby was 13 weeks old. When the baby was reviewed in Dec 2018; increase in vessel tortuosity was noted and the baby was advised for laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 12.12.2018. As on 28.01.2019 ROP has regressed in both eyes and the baby has been advised to review after 2 weeks.

 

 3. A 5 weeks female baby twins born in 29 weeks of gestation weighing 1100 and 1300 gms were evaluated on 29.12.2018; The babies were diagnosed to have ROP in stage 2 in zone 2 with plus disease. The babies were advised for laser intervention to both eyes to avascular retina. The babies underwent both eyes laser treatment on 02.01.2019. As on 16.02.2019 ROP has regressed in both eyes in both babies and are doing well.

All babies are in embrace nest

twin babies treated for ROP
twin babies treated for ROP
4 weeks old baby treated for ROP
4 weeks old baby treated for ROP
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ROP stage 2 eye fundus photo
ROP stage 2 eye fundus photo

In the womb, the retina (the light sensitive surface at the back of the eye that converts images into nerve signals that the brain understands) develops slowly and the retinal blood vessels often only complete growing by the end of gestation. ROP occurs when a baby is born too early to have reached an important milestone in the development of their eyes. It is not passed on from parents to children. The blood vessels that supply this blood usually develop between weeks 16 and 36 of pregnancy. If a child is born prematurely these blood vessels can grow abnormally causing damage to the retina and baby’s vision.

1. A 12 weeks male baby born in 28 weeks of gestation weighing 1000 gms was evaluation on 19.09.2018 by Dr.Krishna R Murthy. The baby was diagnosed to have ROP Retinopathy of Prematurity (ROP) in stage 3 in zone 1 with early plus disease. The baby was advised for laser intervention to both eyes to avascular retina at the earliest. The baby underwent both eyes laser treatment on 22.09.2018. As on 22.10.2018 ROP has regressed in right eye and vitreous haemorrhage in noted in left eye, the baby has been advised to review at base hospital for left eye retinal evaluation at the earliest.

2. A 7 weeks male baby born in 28 weeks of gestation weighing 800 gms was evaluated on 22.10.2018; The baby was under treatment for Respiratory distress syndrome & neonatal jaundice. The baby was kept in the isolation ward for treatment. The fundus photos showed presence of ROP in stage 2 in zone 2 with plus disease. The baby was advised for laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 31.10.2018. As on 12.11.2018 ROP has regressed in both eyes.

3. A 3 weeks old male baby (Twin 1) born in 31 weeks of gestation weighing 1850 gms was seen on 27.10.2018. The baby was diagnosed to have ROP Retinopathy of Prematurity (ROP) in stage 3 in zone 2 with early plus disease. The baby was advised for laser intervention to both eyes to avascular retina at the earliest. The baby underwent both eyes laser treatment on 31.10.2018. As on 17.11.2018 ROP has regressed and is advised to review after 1 week.

Regressed ROP post laser
Regressed ROP post laser
ROP Stage 3
ROP Stage 3
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busy body
busy body

A 4.5 months male baby (now aged 1.9 yrs) which was a preterm male baby born at 30 weeks with birth weight of 1020 gms in the month of September 2016.  The baby had received pan-retinal photocoagualation(PRP) treatment 3 times for the pre-threshold AP-ROP (Aggressive posterior ROP whish is a rapidly progressing, severe form of ROP) in both eyes. Despite lasertreatment, retinopathy progressed to partially retinal detachment sparing the macula(stage 4A).

 

Characteristic features of this type of ROP are a posterior location, plus disease, and the ill-defined nature of the retinopathy, which usually progresses to stage 5 (total retinal detachment) if untreated.

 

The baby was treated withsurgical intervention of Vitrectomy with Encircling Band + Cyrotherapy under general anaesthesia. This Surgical intervention of Vitrectomy for the above ROP baby resulted in achievement retinal reattachment & of loss of vision.  Periodical examination under anaesthesia was done to know the status of retina.

 

The baby now aged 1.9 yrs is doing very well and is very busy in his childhood activities and tantrums.  The baby’s activity has brought joy and happiness to the parents & to the treating team.  The team is delighted from this success & will a motivational factor to our efforts and team work.

super hero
super hero
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11 months male baby with both eyes ROP
11 months male baby with both eyes ROP

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 1250 grams or less that are born before 31 weeks of gestation (A full-term pregnancy has a gestation of 38–42 weeks). The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder which usually develops in both eyes is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.

In addition to birth weight and how early a baby is born, other factors contributing to the risk of ROP include anemia, blood transfusions, respiratory distress, breathing difficulties, and the overall health of the infant.

The most effective proven treatments for ROP are laser therapy or cryotherapy. Laser therapy “burns away” the periphery of the retina, which has no normal blood vessels. While ROP treatment decreases the chances for vision loss, it does not always prevent it. Not all babies respond to ROP treatment, and the disease may get worse. If treatment for ROP does not work, a retinal detachment may develop. 

1. 11 month old male baby was seen at our hospital on 18.01.2018. Baby is a preterm baby born at 32 weeks of gestation. The child’s parents informed of noticing white reflex in both eyes since 2 months. During visual acuity examination the child was not able to fix and follow light in both eyes. Anterior segment examination showed white reflex in both eyes. B-scan was done to know the status of retina. The test showed bilateral funnel retinal detachment secondary to ROP. As child was uncooperative for detailed examination, the child was suggested for EXAMINATION UNDER ANAESTHESIA.

The findings of the examination were as below:-

Right eye – stage 4 ROP

Left eye – Stage 5 ROP with closed funnel retinal detachment

ADVICE:-

  • RIGHT EYE – LASER TREATMENT
  • LEFT EYE - SURGICAL INTERVENTION OF VITRECTOMY + LENSECTOMY + MEMBRANE PEELING    UNDER GENERAL ANAESTHESIA UNDER VERY GUARDED VISUAL PROGNOSIS.

The child underwent the above suggested surgery on 16.03.2018. As on 18.05.2018 the baby has been advised to review after 1 month for visual assessment.

2. A female baby born in 25 week of gestation weighing 660 gms was evaluated on 12.02.2018; the baby was diagnosed to have Retinopathy of Prematurity (ROP) in stage 2 in zone 1 with plus disease. The baby was advised for laser intervention at the earliest. The baby had conjunctivitis; it was treated with topical drops for clear of infection and the baby underwent both eyes laser treatment on 15.02.2018. As on 17.03.2018; ROP has regressed in both eyes post laser treatment and the baby is doing well. Baby has been advised to review after 2 weeks.

3. A female baby born in 29 week of gestation weighing 760 gms was evaluated on 19.02.2018; The fundus photos did not show presence of ROP and the baby was advised for review after 2 weeks. The baby was reviewed on 19.03.2018; diagnosed to have ROP Retinopathy of Prematurity (ROP) in stage 2 in zone 2 with plus disease. The baby was advised for laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 24.03.2018.

 

11 month male baby operated for stage 5 ROP
11 month male baby operated for stage 5 ROP
29 weeks old female baby treated for ROP
29 weeks old female baby treated for ROP
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ROP - Pre and post laser photos
ROP - Pre and post laser photos

Retinopathy of prematurity (ROP) is a disease of the retina that can occur in premature babies. The retina is the thin, light-sensitive tissue that lines the inside surface of the eye. Cells in the retina convert incoming light into electrical impulses. These electrical impulses are carried by the optic nerve to the brain, which finally interprets them as visual images. ROP is classified by the part of the retina affected (zone), the degree of involvement (stage), and the appearance of the blood vessels (presence or absence of "plus" disease).

 Individuals with ROP are considered to be at higher risk for developing certain eye problems later in life, such as retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma. In many cases, these eye problems can be treated or controlled. Thus, it is important for patients with a history of ROP to have regular dilated eye examinations by an ophthalmologist even after the ROP has regressed.

 

  1. Baby of Madhavi born in 27 week of gestation, weighing 1000 gms male baby was evaluated in 8th week post birth. The baby was diagnosed to have Retinopathy of Prematurity (ROP) in stage 2 in zone 1 with plus disease in both eyes. The baby underwent both eyes laser treatment on 04.12.2017. As on 30.12.2017; the baby is doing well and ROP has regressed post laser treatment.
  2.  Baby of Reena born in 30 week of gestation, weighing 1200 gms female baby was evaluated in 6th week post birth. The fundus pictures showed presence of ROP in left eye in stage 2 in Zone 2; right eye was within normal limits. The baby was advised to review after 1 week. The baby was reviewed on 11.12.2017; fundus pictures showed presence of ROP in both eyes in stage 2 in zone 2 with plus disease. The baby was advised for early laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 14.12.2017. As on 05.02.2018; the baby is doing well and ROP has regressed post laser treatment.
  3.  Baby of Leela Bai born in 30 week of gestation, weighing 1300 gms male babywas evaluated in 2nd week post birth; the fundus pictures were within normal limits. The baby was advised to review after 2 weeks as retina was vascularized beyond equator in both eyes. The baby was reviewed on 11.12.2017; fundus pictures showed presence of ROP in stage 2 in Zone 2 with plus disease; left eye in stage 2 in zone 2 with no plus disease. The baby was advised for early laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 14.12.2017. As on 08.01.2018; the baby is doing well and ROP has regressed post laser treatment.
  4. Baby of Nilafar born in 26 week of gestation, weighing 850 gms female baby. The baby was evaluated in 2nd week post birth; there was no presence of ROP. The baby was on close review to monitor the ROP status. When the baby was reviewed in 6th week; the fundus pictures showed Retinopathy of Prematurity (ROP) in stage 2 in zone 1 with plus vascularisation close to fovea. (Choroid vascularises at 6 weeks, Retinal Vascularisation starts at optic nerve head at 16 week gestation. Vascularisation is almost complete by term). The Baby was advised for administration of Antivegf intravitreal injection - Accentrix to both eyes at the earliest. Antibody binds the VEGF inside the eye almost immediately. The baby was administered Antivegf injection to both eyes on 15.01.2018. As on 24.02.2018; the eye quite and has been advised for close observation.
Baby of Nilafar - treated with antivegf injection
Baby of Nilafar - treated with antivegf injection
Baby of Leela Bai
Baby of Leela Bai
Baby of Reena
Baby of Reena
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Organization Information

Vittala International Institute of Ophthalmology

Location: Bengaluru, Karnataka - India
Website:
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Vittala International Institute of Ophthalmology
Krishna Murthy
Project Leader:
Krishna Murthy
Medical Director
Bangalore, Karnataka India

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