Retinopathy of Prematurity

 

Reviewed by Carl Kuschel and Shuan Dai (Ophthalmology)
October 2007
Clinical Guidelines Back Newborn Services Home Page
Which Babies are Screened? Classification System When are Babies Screened? Examination
Transfer to Another Hospital Follow-up References Related Documents

Which Babies are Screened?

Classification System

ROP Classification System

Stage 1

Demarcation line -a flat, thin, whiteish, clear-cut demaraction between vascularised and avascular retina (normal retina has a tenuous, non-linear, feathery border) ROP stage1.jpg (74277 bytes)

Stage 2

Elevated ridge - demarcation line now has "3" dimensions ROP stage 2.jpg (38892 bytes)

Stage 3

Neovascularisation - extra-retinal, fibrovascular proliferative tissue ROP stage 3.jpg (42464 bytes)

Stage 4

Retinal detachment - may be exudative and/or tractional, and may be partial or total  
4A – macular not involved
4B – macular detached

Stage 5

Total retinal detachment

Plus Disease

Presence of dilatation and tortuosity of the posterior pole blood vessel involving at least two quadrants of the retina. This is associated with severe disease and worse outcomes.
It is more likely to occur with higher stages and lower zones
Pre-Plus Disease:  more arterial tortuosity and venous dilatation than normal but not severe enough to be classified as "Plus disease".  
"Rush" Disease (Aggressive Posterior ROP, AP-ROP):  A rare and severe form of ROP with increased tortuosity and dilatation of vessels present in all 4 quadrants of zone 1 and sometimes zone 2.  May not sequentially advance through Stage 1 to 3 but often rapidly advances to stage 4 or 5.  

When are Babies Screened?

Gestational Age at Birth First Examination
<26 weeks 1st Tuesday after 30 weeks PMA
26 weeks 1st Tuesday after 31 weeks PMA
27-28 weeks 1st Tuesday after 32 weeks PMA
29-31 weeks 1st Tuesday after 33 weeks PMA
≥32 weeks 1st Tuesday when over 3 weeks old

PMA=postmenstrual age.  Click here to open the corrected age calculator.

Examination Timing Retinal Findings
1 week follow-up Stage 1 or stage 2 ROP in Zone I, or
Stage 3 in Zone II
1-2 weekly follow-up Immature vessels in Zone I (No ROP), or
Stage 2 ROP in Zone II, or
Regressing ROP in Zone I
2 weekly follow-up Stage 1 ROP in Zone II, or
Regressing ROP in Zone II
2-3 weekly follow-up Immature vessels in Zone 2 (no ROP), or
Stage 1 or 2 in Zone III, or
Regressing ROP in Zone III

Examination

Transfer to Another Hospital

Follow-up

References

1 Section on Ophthalmology American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2006;117(2):572-6.
2 International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005;123:991-9.
3 Wheatley CM, Dickinson JL, Mackey DA, Craig JE, Sale MM. Retinopathy of prematurity: recent advances in our understanding. Arch Dis Child Fetal Neonatal Ed 2002;87(2):F78-82.
4 Nodgaard H, Andreasen H, Hansen H, Sorensen HT. Risk factors associated with retinopathy of prematurity in northern Jutland, Denmark, 1990-1993.. Acta Ophthalmol Scand 1996;74:306-10.
5 Todd D, Kennedy J, Roberts V, John E. Risk factors in progression beyond stage 2 retinopathy of prematurity. Aust N Z J Ophthalmol 1990;18(1):57-60.
6 Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial.. Arch Ophthalmol 2003;121:1684-94.
7 Early Treatment for Retinopathy of Prematurity Cooperative Group. Multicenter trial of early treatment for retinopathy of prematurity: study design. Controlled Clinical Trials 2004;25:311-25.
8 Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the early treatment for retinopathy of prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc 2004;102:233-50.
9 Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results. Arch Ophthalmol 1988;106:471-9.
10 Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: ophthalmological outcomes at 10 years. Arch Ophthalmol 2001;119:1110-18.
11 Cryotherapy for Retinopathy of Prematurity Cooperative Group.. 15-year outcomes following threshold retinopathy of prematurity: final results from the multicenter trial of cryotherapy for retinopathy of prematurity. Arch Ophthalmol 2005;123(3):311-8.
12 Ng EY, Connolly BP, McNamara JA, Regillo CD, Vander JF, Tasman W. A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 1. Visual function and structural outcome. Ophthalmology. 2002 May;109(5):928-34.
13 Connolly BP, Ng EY, McNamara JA, Regillo CD, Vander JF, Tasman W. A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 2. Refractive outcome. Ophthalmology. 2002 May;109(5):936-41.