How Retinopathy of Prematurity Is Treated

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Retinopathy of prematurity (ROP) is a sight-disabling disease that only affects infants born prematurely, usually before 32 weeks of pregnancy.

Vision loss occurs because blood vessels in the eye do not fully develop before late pregnancy. When an infant is born prematurely, the blood vessels continue their growth but abnormally. The abnormal growth creates scar tissue on the eye and tension that pulls the retina away from the back of the eye to form a retinal detachment.

This article discusses treatment options for retinopathy of prematurity, including surgical procedures.

A pediatrician checking an 8 month old baby's eyes with a penlight

sdominick / Getty Images

Stages

Treatment for ROP depends on disease severity and what part of the eye is affected. The only treatments for ROP are surgical procedures. There are no over-the-counter (OTC) or prescription medications that treat ROP.

There are five different stages of the disease, with stage 1 being the mildest and stage 5 being the most severe.

Infants with stage 1 or 2 ROP may not need further treatment because sometimes the tissue heals on its own and does not lead to other problems.

However, all infants born prematurely must have regular eye examinations to determine the need for treatment, even if the infant was initially diagnosed with mild stage 1 disease. Clinicians generally recommend treatment for ROP stage 3 and beyond.

Stage 5 ROP

An infant with stage 5 ROP has a completely detached retina and will develop severe vision problems or blindness.

Surgeries and Procedures

To treat ROP in infants who have severely abnormal blood vessel growth in the outer parts of the eye, a surgical procedure to destroy the abnormal blood vessels is required. An eye specialist might recommend surgery for infants with ROP of any severity, but particularly for stages 3, 4, or 5.

Laser Therapy

Laser therapy is the most common treatment approach for ROP. It is more effective and has better long-term outcomes than the previously used method, cryotherapy (using freezing or near-freezing temperatures), which it has essentially replaced.

Laser therapy involves burning away the abnormal blood vessels that grow on the edges of the eye. The treatment destroys the peripheral (side) vision, but it saves the most important part of sight, the central vision. This means that children will see what's happening straight in front of them, but they may not notice objects in their peripheral visual field.

Injection Medication (Avastin or Lucentis)

Another newer treatment option involves injecting a medication, Avastin (bevacizumab) or Lucentis (ranibizumab) into the eye that stops abnormal blood vessel growth by inhibiting cellular signals. Since this procedure consists of an injection without further surgical care, many ophthalmologists (eye specialists) prefer this as initial therapy.

Injection medications stop the signaling of a chemical called vascular endothelial growth factor (VEGF). Without this signal, blood vessels will not grow.

Eye surgeons can use these medications alone or in combination with laser therapy. They are equally effective as laser therapy and may even reduce disease recurrence better than laser therapy.

While studies are ongoing, there is some concern that these medications may lead to stunted growth of blood vessels elsewhere in the body. Further research is being conducted to evaluate the long-term side effects of these injections.

Early Procedures for ROP

Even with surgical management of ROP, the disease can continue to worsen, and children can develop a retinal detachment. Children who already have severe ROP associated with a partial retinal detachment or who develop a retinal detachment after initial treatments have the option of more invasive procedures to try to save their vision.

Scleral Buckle

A scleral buckle is only performed in children with severe ROP.

The procedure involves placing a tight band around the eye to keep the gel inside the eye (the vitreous gel) from pulling on the scar tissue that develops from abnormal blood vessel growth. If the vitreous is not pulling on the scar tissue, the retina can adhere to the wall.

It's important to note that a scleral buckle will eventually need to be removed to allow the eye to grow as the child grows.

Vitrectomy

A vitrectomy is an invasive procedure that involves removing the vitreous gel from inside the eye and replacing it with a sterile salt solution. The surgeon also removes the scar tissue that develops around the abnormal blood vessels.

Vitrectomy allows the retina to lay back down against the eye and not be peeled away by the scar tissue. However, this procedure is successful only approximately 30% of the time.

Over-the-Counter Prevention Therapy

Arachidonic and docosahexaenoic acids are omega-3 fatty acids that are critical parts of eye and brain development. These nutrients are transferred from a pregnant person to a growing fetus during late pregnancy.

Infants born prematurely lack these essential nutrients. Researchers recently determined that supplementation of infant formula with these fatty acids reduces the risk of developing severe ROP.

Breastfeeding and ROP

Recent studies show that breastfeeding is a protective measure to prevent ROP in premature infants and limit worsening disease in those who already have ROP.

Summary

Retinopathy of prematurity is a sight-disabling disorder of premature infants that can only be treated with surgical procedures. Sometimes ROP does not need further treatment if it's mild. Still, it's essential to discuss treatment options with a pediatrician and eye specialist.

A Word From Verywell

If your baby is born prematurely, speak with your pediatrician and an eye specialist about regular eye examinations. Retinopathy of prematurity is treatable. Recommended preventive strategies and regular follow-up with an eye specialist will determine current and future needs.

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5 Sources
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