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Ophthalmology Oct 2021The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of... (Review)
Review
PURPOSE
The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system.
DESIGN
Review of evidence-based literature, along with expert consensus opinion.
PARTICIPANTS
International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men.
METHODS
The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification.
MAIN OUTCOME MEASURES
Consensus statement.
RESULTS
The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae.
CONCLUSIONS
These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.
Topics: Diagnostic Imaging; Disease Progression; Gestational Age; Humans; Infant, Newborn; Retina; Retinopathy of Prematurity
PubMed: 34247850
DOI: 10.1016/j.ophtha.2021.05.031 -
Developmental Medicine and Child... May 2023Retinopathy of prematurity (ROP) is a devastating neurovascular disease of the retina in newborn infants that can lead to vision deficits or even blindness. In this... (Review)
Review
Retinopathy of prematurity (ROP) is a devastating neurovascular disease of the retina in newborn infants that can lead to vision deficits or even blindness. In this concise review we discuss our current knowledge about diagnosis, etiology, pathogenesis, intervention, and outcomes of the disease. Major advancements have been made both in categorizing the disease in the new International Classification of Retinopathy of Prematurity, Third Edition classification and in treating severe ROP with anti-vascular endothelial growth factor (VEGF) agents. New development always creates new questions and opens up new areas of research. We will discuss in this review both the benefits and downsides of the new anti-VEGF treatment approaches in ROP, especially in light of our improved understanding of the underlying ROP pathophysiology. We also offer pointers to areas where more research is needed. WHAT THIS PAPER ADDS: Concise update on all aspects of retinopathy of prematurity (ROP), including advances in understanding and treatment. Benefits and risks of the new treatment method of anti-vascular endothelial growth factor injections in ROP are discussed. New research areas that deserve attention in the coming years are identified.
Topics: Infant, Newborn; Infant; Humans; Retinopathy of Prematurity; Vascular Endothelial Growth Factor A; Endothelial Growth Factors; Infant, Premature; Retina
PubMed: 36408783
DOI: 10.1111/dmcn.15468 -
Medecine Sciences : M/S Oct 2020Retinopathy of prematurity (ROP) is one of the leading cause of preventable blindness in children. Its incidence increases with increasing survival of extremely preterm... (Review)
Review
Retinopathy of prematurity (ROP) is one of the leading cause of preventable blindness in children. Its incidence increases with increasing survival of extremely preterm babies. ROP results from a multifactorial impairment of retinal development, the retinal vascular network, involving both oxygen-dependent and nutritional factors. The numerous factors involved in ROP development suggest that preventive strategies should be synergistic and complementary, including tight control of oxygen therapy, optimized nutritional intakes and postnatal growth, breastfeeding, adequate ω-3 PUFAs supply and control of hyperglycemic episodes associated with prematurity. ROP requires a multidisciplinary management, which includes systematic screening, appropriate treatment and long-term follow-up. Current screening modalities are based on wide-field digital retinal imaging systems, which also allow screening by telemedicine. The gold-standard treatment for ROP remains laser photocoagulation. It may be combined with intravitreal anti-VEGF administration, which is currently being evaluated, or surgery for advanced stages.
Topics: Humans; Incidence; Infant, Newborn; Infant, Premature; Monitoring, Physiologic; Nutritional Status; Oxygen; Retinopathy of Prematurity; Risk Factors
PubMed: 33026333
DOI: 10.1051/medsci/2020163 -
North Carolina Medical Journal 2017Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder unique to premature infants. As premature births increase in many areas of the world, ROP has...
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder unique to premature infants. As premature births increase in many areas of the world, ROP has become a leading cause of childhood blindness. A better understanding of the pathogenesis of ROP, adherence to strict screening guidelines, and evolution of treatment options have reduced the number of sight-threatening complications from ROP.
Topics: Humans; Infant, Newborn; Neonatal Screening; Retinopathy of Prematurity; Risk Factors
PubMed: 28420777
DOI: 10.18043/ncm.78.2.124 -
American Journal of Ophthalmology Oct 2020To discuss the evolution in retinopathy of prematurity since its first description as retrolental fibroplasia in the United States, including the changes in the... (Review)
Review
PURPOSE
To discuss the evolution in retinopathy of prematurity since its first description as retrolental fibroplasia in the United States, including the changes in the understanding of pathophysiology; methods of diagnosis; destructive, anti-vascular endothelial growth factor (anti-VEGF), and supportive treatments; and differences in retinopathy of prematurity manifestations worldwide. The overall goal is to clarify retinopathy of prematurity currently and formulate questions to optimize future care.
STUDY DESIGN
Literature review and synthesis.
METHODS
Critical review and consideration of the literature with inclusion of historical articles and those regarding pathophysiologic risk factors, retinopathy of prematurity worldwide, basic and clinical science particularly regarding anti-VEGF mechanisms and agents tested in clinical trials.
RESULTS
Retinopathy of prematurity has evolved from affecting infants approximately 2 months premature to affecting extremely premature infants. Worldwide, retinopathy of prematurity differs and, in emerging countries, has features similar to that experienced in the United States when retinopathy of prematurity first manifested. Treatments have evolved from destruction of the peripheral avascular retina to inhibit angiogenic stimuli to anti-VEGF agents, which inhibit pathologic angiogenesis but also extend normal intraretinal angiogenesis by ordering the development of intraretinal vessels. Clinical trial evidence is accruing with the goal to develop less destructive treatments to optimize vision and that are protective to the retina and infant.
CONCLUSIONS
Goals for retinopathy of prematurity are to optimize prenatal and perinatal care, improve diagnostic acumen worldwide and refine treatment strategies, including with anti-VEGF agents, to inhibit intravitreal angiogenesis and facilitate vascularization of the previously avascular retina, which include supporting neural and vascular development of the premature infant and retina.
Topics: Angiogenesis Inhibitors; Bevacizumab; Global Health; Humans; Infant, Newborn; Infant, Premature; Intravitreal Injections; Retinopathy of Prematurity; Vascular Endothelial Growth Factor A
PubMed: 32450064
DOI: 10.1016/j.ajo.2020.05.025 -
Progress in Retinal and Eye Research Mar 2018Development of the retinal vasculature is based on highly coordinated signalling between different cell types of the retina, integrating internal metabolic requirements... (Review)
Review
Development of the retinal vasculature is based on highly coordinated signalling between different cell types of the retina, integrating internal metabolic requirements with external influences such as the supply of oxygen and nutrients. The developing mouse retinal vasculature is a useful model system to study these interactions because it is experimentally accessible for intra ocular injections and genetic manipulations, can be easily imaged and develops in a similar fashion to that of humans. Research using this model has provided insights about general principles of angiogenesis as well as pathologies that affect the developing retinal vasculature. In this review, we discuss recent advances in our understanding of the molecular and cellular mechanisms that govern the interactions between neurons, glial and vascular cells in the developing retina. This includes a review of mechanisms that shape the retinal vasculature, such as sprouting angiogenesis, vascular network remodelling and vessel maturation. We also explore how the disruption of these processes in mice can lead to pathology - such as oxygen induced retinopathy - and how this translates to human retinopathy of prematurity.
Topics: Animals; Disease Models, Animal; Humans; Intercellular Signaling Peptides and Proteins; Neovascularization, Pathologic; Neovascularization, Physiologic; Retinal Vessels; Retinopathy of Prematurity
PubMed: 29129724
DOI: 10.1016/j.preteyeres.2017.11.001 -
Indian Journal of Ophthalmology Feb 2020
Topics: Delivery of Health Care; Gestational Age; Global Health; Humans; Infant, Newborn; Morbidity; Neonatal Screening; Ophthalmology; Quality of Health Care; Retinopathy of Prematurity
PubMed: 31937721
DOI: 10.4103/ijo.IJO_2378_19 -
Hong Kong Medical Journal = Xianggang... Aug 2023
Topics: Infant, Newborn; Humans; Rejuvenation; Retinopathy of Prematurity; Infant, Premature
PubMed: 37589083
DOI: 10.12809/hkmj235148 -
Indian Journal of Ophthalmology Nov 2023
Topics: Infant, Newborn; Humans; Retinopathy of Prematurity; Infant, Premature; Gestational Age
PubMed: 37869999
DOI: 10.4103/IJO.IJO_2714_23 -
Eye (London, England) Apr 2020Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible... (Review)
Review
Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.
Topics: Asia; Child; Humans; India; Infant; Infant, Newborn; Infant, Premature; Retinal Detachment; Retinopathy of Prematurity
PubMed: 31664193
DOI: 10.1038/s41433-019-0643-4