eMedicine Specialties > Ophthalmology > Retina

Retinopathy of Prematurity: Differential Diagnoses & Workup

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Coauthor(s): Johanne Menassa, MD, Staff Physician, Department of Ophthalmology, University of Laval Hospital, Quebec City; C Corina Gerontis, MD, Consulting Staff, Departments of Pediatrics and Ophthalmology, Schneider Children's Hospital/Long Island Jewish Medical Center
Contributor Information and Disclosures

Updated: Nov 3, 2008

Differential Diagnoses

Retinoblastoma

Other Problems to Be Considered

Familial exudative vitreoretinopathy (FEVR)
Primary hyperplastic primary vitreous (PHPV)
Norrie disease

Workup

Imaging Studies

  • In 2008, a telemedicine study showed that single-image and multiple-image telemedicine examinations perform comparably in the determination of a recommended follow-up interval and in the detection of plus disease.9 In the future, there will likely be an increase and development of screening protocols, particularly in areas with limited access to ophthalmic care.9

Procedures

  • A dilated fundus examination with scleral depression is necessary. The instruments used are a Sauer speculum (to keep the eyes gently open), a Flynn scleral depressor (to rotate and depress small eyes), and a 28-diopter lens (for proper identification of zones).
  • The first part of the examination should be external, with identification of iris rubeosis, if present. The next part of the examination should be the posterior pole, with identification of any plus disease or straightening of the vascular arcades. The eye is rotated to identify the presence or absence of zone 1 disease (if the ridge and the optic nerve are present in the same view, this usually implies zone 1). If the nasal vessels are not at the nasal ora serrata, this is still zone 2. If the nasal vessels have reached the nasal ora serrata, the eye is in zone 3.

More on Retinopathy of Prematurity

Overview: Retinopathy of Prematurity
Differential Diagnoses & Workup: Retinopathy of Prematurity
Treatment & Medication: Retinopathy of Prematurity
Follow-up: Retinopathy of Prematurity
Multimedia: Retinopathy of Prematurity
References
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References

  1. Terry TL. Extreme prematurity and fibroplastic overgrowth of persistent vascular sheath behind each crystalline lens I. Preliminary report. Am J Ophthalmol. 1942;25:203-4.

  2. Campbell K. Intensive oxygen therapy as a possible cause for retrolental fibroplasia. A clinical approach. Med J Austr. 1951;2:48-50.

  3. Kretzer FL, Hittner HM. Retinopathy of prematurity: clinical implications of retinal development. Arch Dis Child. Oct 1988;63(10 Spec No):1151-67. [Medline].

  4. Ashton N. Oxygen and the retinal blood vessels. Trans Ophthalmol Soc U K. Sep 1980;100(3):359-62. [Medline].

  5. Csak K, Szabo V, Szabo A, et al. Pathogenesis and genetic basis for retinopathy of prematurity. Front Biosci. Jan 1 2006;11:908-20. [Medline].

  6. Fielder AR, Shaw DE, Robinson J, et al. Natural history of retinopathy of prematurity: a prospective study. Eye. 1992;6 (Pt 3):233-42. [Medline].

  7. Varughese S, Gilbert C, Pieper C, et al. Retinopathy of prematurity in South Africa: an assessment of needs, resources and requirements for screening programmes. Br J Ophthalmol. Jul 2008;92(7):879-82. [Medline].

  8. Palmer EA, Flynn JT, Hardy RJ, et al. Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology. Nov 1991;98(11):1628-40. [Medline].

  9. Lajoie A, Koreen S, Wang L, et al. Retinopathy of prematurity management using single-image vs multiple-image telemedicine examinations. Am J Ophthalmol. Aug 2008;146(2):298-309. [Medline].

  10. Repka MX, Hardy RJ, Phelps DL, et al. Surfactant prophylaxis and retinopathy of prematurity. Arch Ophthalmol. May 1993;111(5):618-20. [Medline].

  11. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity. One-year outcome--structure and function. Arch Ophthalmol. Oct 1990;108(10):1408-16. [Medline].

  12. 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. Dec 2003;121(12):1684-94. [Medline].

  13. Laser ROP Study Group. Laser therapy for retinopathy of prematurity. Arch Ophthalmol. Feb 1994;112(2):154-6. [Medline].

  14. Phelps DL. Retinopathy of prematurity: an estimate of vision loss in the United States--1979. Pediatrics. Jun 1981;67(6):924-5. [Medline].

  15. Repka MX, Tung B, Good WV, et al. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP). Arch Ophthalmol. Jan 2006;124(1):24-30. [Medline].

  16. Reynolds JD, Hardy RJ, Kennedy KA, et al. Lack of efficacy of light reduction in preventing retinopathy of prematurity. Light Reduction in Retinopathy of Prematurity (LIGHT-ROP) Cooperative Group. N Engl J Med. May 28 1998;338(22):1572-6. [Medline].

  17. Schaffer DB, Palmer EA, Plotsky DF, et al. Prognostic factors in the natural course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology. Feb 1993;100(2):230-7. [Medline].

  18. 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. Feb 2006;117(2):572-6. [Medline].

  19. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics. Feb 2000;105(2):295-310. [Medline].

  20. The Committee for the Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Arch Ophthalmol. Aug 1984;102(8):1130-4. [Medline].

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Further Reading

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Keywords

retinopathy of prematurity, ROP, retrolental fibroplasia, retinal vasculature, retinal vessels, retinal detachment, RLF, vision loss, visual loss, blindness

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Johanne Menassa, MD, Staff Physician, Department of Ophthalmology, University of Laval Hospital, Quebec City
Disclosure: Nothing to disclose.

C Corina Gerontis, MD, Consulting Staff, Departments of Pediatrics and Ophthalmology, Schneider Children's Hospital/Long Island Jewish Medical Center
C Corina Gerontis, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

V Al Pakalnis, MD, PhD, Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center
V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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