Eye Screening for Premature Babies

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.

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 8^th 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 6^th 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 2^nd 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 2^nd 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 6^th 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.