Education  India Project #19979

Eye Screening for Premature Babies

by Vittala International Institute of Ophthalmology
Eye Screening for Premature Babies
Stage 2 ROP fundus photo
Stage 2 ROP fundus photo

Retinopathy of prematurity (ROP) is a disease of the eye affecting prematurely born babies generally having received intensive neonatal care, in which oxygen therapy is used on them due to the premature development of their lungs. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases.

As such, all preterm babies are at risk for ROP, and very low birth-weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP. During development, blood vessels grow from the central part of the retina outwards. This process is completed a few weeks before the normal time of delivery. However, in premature babies it is incomplete. If blood vessels grow normally, ROP does not occur. If the vessels grow and branch abnormally the baby develops ROP. These abnormal blood vessels may grow up from the plane of the retina and may bleed inside the eye. When the blood and abnormal vessels are reabsorbed, it may give rise to multiple bands like membranes which can pull up the retina, causing detachment of the retina and eventually blindness before 6 months.

 

  1. Mst.Mohammed born in 26 week of gestation, weighing 1000 gms male baby. The baby was diagnosed to have ROP in stage 2 in zone 1 (location of the disease in the eye) both eyes and was treated with timely laser intervention. As on 21st November 2017 the ROP has regressed in both eyes.
  2. Baby of Mallamma (Twin I & II) born in 32 week of gestation, both weighing 1500 gms male babies.The babies were diagnosed to have Retinopathy of Prematurity (ROP) in stage 2 in zone 2 with plus disease in both eyes. The babies were treated with laser intervention.
  3. Baby of Rohini born in 29 week of gestation, weighing 1700 gms male baby. The baby was diagnosed to have APROP (Aggressive Posterior Retinopathy of Prematurity). The baby was treated with timely intervention of laser treatment.
  4. Baby of Sandya born in 30 week of gestation, weighing 1240 gms female baby was diagnosed to have ROP in stage 3 ROP with plus disease. Right eye showed pre-retinal haemorrhages. The baby was treated with laser intervention. As on 29.11.2017; ROP is regressing, pre-retinal haemorrhage is present and has been advised for close monitoring.

Jewel of the body safeguarded with timely treatment.

Regressed ROP Fundus Photo post treatment
Regressed ROP Fundus Photo post treatment
ROP fundus photo with preretinal haemorrhage
ROP fundus photo with preretinal haemorrhage
baby treated for preretinal haemorrhage
baby treated for preretinal haemorrhage
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APROP Fundus Photo
APROP Fundus Photo

Retinopathy of Prematurity (ROP), originally called retrolental fibroplasia, was the leading cause of blindness in children in the 1940s and 1950s. ROP occurs when abnormal blood vessels grow and spread throughout the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment. Retinal detachment is the main cause of visual impairment and blindness in ROP. ROP was first diagnosed in 1942.

Babies screened within the 1st month of life and treated with laser immediately when the baby is still in NICU can preserve the vision completely.

 Under ROP programme the following babies were diagnosed and treated.

 

  1. Baby of Jayashree -born in 29 week of gestation, weighing 1300gms male baby. The baby was diagnosed to have APROP – Aggressive Posterior in both eyes.  The baby was treated with intravitreal antivegf Accentrix injection to both eyes. Anti-VEGF injections are used in ROP only when the standard treatment of laser fails and the disease progresses. The treatment has rapid reponse. It may take a week for laser treatment to stop progression of disease, but the antibody binds the VEGF inside the eye almost immediately. Antivegf is the use of medications that block vascular endothelial growth factor.

  2. Baby of Lathashree – born in 31 week of gestation, weighing 1420gms male baby. The baby was diagnosed to have ROP in stage 2 in zone 2 (location of the disease in the eye) both eyes and was treated with timely laser intervention. 

  3. Baby of Roopa twin 1st – born in 29 week of gestation, weighing 950 gms Female baby. The baby was diagnosed to have ROP in stage 2 in zone 2 both eyes and was treated with laser treatment.

  4. Baby of Roopa twin 2nd – born in 29 week of gestation, weighing 1100 gms Female baby. The baby was diagnosed to have ROP in stage 2 in zone 2 both eyes and was treated with laser treatment.

  5. Baby of Shaheen – born in 28 week of gestation, weighing 1000gms male baby. The baby was on ventilator support for 1 ½ months and was diagnosed to have ROP in stage 2 in zone 1 in both eyes.  The baby was treated with laser intervention to both eyes.

 

ROP is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.  All the above babies were treated with timely treatment interventions and further progression of the disease was prevented.

ROP stage 2 Fundus Photo
ROP stage 2 Fundus Photo
Baby of Shaheen treated for ROP stage 2
Baby of Shaheen treated for ROP stage 2
treated for APROP
treated for APROP
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baby of suma
baby of suma

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 2000 grams or less that are born before 36 weeks of gestation. 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.

ROP occurs when abnormal blood vessels grow and spread throughout the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment. Retinal detachment is the main cause of visual impairment and blindness in ROP.

With advent of technology, hospital has been delivering ROP screening in far flung NICUs using advanced RETCAM imaging system coupled with an innovative tele medical solution for diagnosis and treatment planning. Under this project few babies who underwent laser treatment are as below:-

 

  1. Baby of Suma – born in 33 week of gestation, weighing 1370gms male baby. The baby was diagnosed to have ROP in stage 3 in both eyes and was treated with laser intervention. Complete functional vision can be saved in infants when diagnosed and treated in time.
  2. Baby of Kanaka twin 1st – born in 31 week of gestation, weighing 1300 gms male baby. The baby was diagnosed to have ROP in stage 2 in both eyes and was treated with laser treatment.
  3. Baby of Kanaka twin 2nd – born in 31 week of gestation, weighing 1400 gms male baby. The baby was diagnosed to have ROP in stage 2 in both eyes and was treated with laser treatment.
  4. Baby of Husna Babu twin 2nd – born in 28 week of gestation, weighing 1340gms female baby. The baby was diagnosed to have ROP in stage 3 in right eye with no evidence of ROP in left eye. The baby was treated with laser intervention in right eye.

All the above babies were treated with timely intervention of laser treatment and further progression of the disease to more severe stage was controlled.

baby of Husna Banu
baby of Husna Banu
Baby of Kanaka Twin 1
Baby of Kanaka Twin 1
Baby of Kanaka Twin 2
Baby of Kanaka Twin 2
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AP-ROP fundus photo
AP-ROP fundus photo

Baby of Madhavi, 4.5 months male baby

 Baby of Madhavi is 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. The baby was reviewed in the month 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.

 
 

Plan of treatment

Timely surgical intervention of Vitrectomy with Encircling Band + Cyrotherapy under general anaesthesia was done to both eyes. Surgical intervention of Vitrectomy for stage 4a ROP could achieve retinal reattachment & avoid of loss of vision.

4.5 MONTHS OLD MALE BABY OPERATED FOR ROP
4.5 MONTHS OLD MALE BABY OPERATED FOR ROP
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Fundus Photo of Baby of Jyothi showing stage 4 ROP
Fundus Photo of Baby of Jyothi showing stage 4 ROP

Baby of Jyothi, 10 months male baby

 

Baby of Jyothi is a preterm male baby born at 30 weeks with birth weight of 1500gms.  The baby was seen on 08.11.2016 at Davangere, Karnataka, India. The examination showed Retinopathy of Prematurity in stage 4 in both eyes. In left eye retinal detachment temporal to macula was noted. The surgeon explained the emergency situation of the baby’s ROP stage & parents were advised to get the baby to Bangalore for laser intervention. The baby was treated with laser to both eyes on 09.11.2016. The baby was advised to review at base hospital for left eye management which requires surgical management of Vitrectomy. 

 

Management of stage 4 ROP becomes difficult as it progresses.Macula is the central part of the retina which contains the fovea which is essential for a clear vision in the eye. Any distortion of the macula or any macular detachment will lead to a decrease in vision. Therefore it is very important to control the disease in stage 3 itself, so that it does not progress to stage 4, wherein the macula may be threatened.

 

Plan of treatment

Timely laser intervention has been done to both eyes, in right eye ROP progression has regresseed and surgical intervention of Vitrectomy to left eye has been planned. Surgical intervention of Vitrectomy basically involves relief of traction over the Ridge, such that the retina can fall back or the traction and retinal detachment progression is prevented.

Baby of Jyothi
Baby of Jyothi
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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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