eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Retinopathy of Prematurity: Follow-up

Author: KN Siva Subramanian, MD, Professor of Pediatrics and Obstetrics/Gynecology, Chief of Neonatal Perinatal Medicine, Director of Nurseries, Georgetown University Hospital
Coauthor(s): Monisha Bahri, MBBS, MD, Fellow in Neonatal/Perinatal Medicine, Department of Neonatology, Georgetown University Hospital; Gonzalo (Vike) Vicente, MD, FAAP, Consulting Ophthalmologist, Eye Doctors of Washington
Contributor Information and Disclosures

Updated: Jun 29, 2009

Follow-up

Further Inpatient Care

  • Base follow-up examinations in patients with retinopathy of prematurity (ROP) on previous examination results. The more immature the retinal vasculature or the more serious the disease, the shorter the follow-up interval must be to enable the detection of disease. These examinations allow treatment to be offered if threshold disease develops in the eye.
  • After surgical intervention, an ophthalmologist should perform an examination every 1-2 weeks to determine if additional surgery is indicated.
  • Patients who are medically monitored must undergo examinations until the retinal vasculature is mature. Ensuring appropriate monitoring of infants is critical if they are discharged from the nursery before retinal vascular maturity is attained.
  • Numerous patients have lost sight due to inappropriate, untimely monitoring. In untreated patients, retinal detachments commonly occur at 38-42 weeks' postmenstrual age.

Further Outpatient Care

  • Patients require yearly ophthalmologic follow-up evaluations. More frequent evaluation may be necessary, depending on the severity of the disease.
  • The long-term outcome for infants with retinopathy of prematurity continues to be problematic. Patients with retinopathy of prematurity are at significant risk for myopia. In addition, strabismus, amblyopia, and late retinal detachment continue to be problems for these infants.
  • Long-term follow-up findings from the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) cooperative group indicate that refractive errors in eyes with mild retinopathy of prematurity are associated with the same risk of myopia as that in eyes without retinopathy of prematurity.8 In patients with moderate-to-severe retinopathy of prematurity, the prevalence of severe myopia is increased. Fifteen year follow-up from the CRYO-ROP Trial shows that children remain at risk for new retinal detachments, even with eyes that have relatively good structural findings at age 10 years.
  • Long-term, regular follow-up of eyes with threshold retinopathy of prematurity is warranted.
  • As stated above, laser surgery offers some advantage over cryotherapy in treating zone I disease.

Deterrence/Prevention

  • The only known deterrent measure is to prevent preterm birth. The more mature a neonate is at birth, the less likely retinopathy of prematurity is to occur.
  • Studies regarding the effects of antenatal corticosteroids on retinopathy of prematurity revealed that this treatment has a protective effect against severe retinopathy of prematurity.22
  • Recent studies have shown that maintaining oxygen saturation values by pulse oximeter (SpO2) at 83-93% decreases the incidence of threshold retinopathy of prematurity.23,24

Complications

  • Late complications include myopia, amblyopia, strabismus, nystagmus, cataracts, retinal breaks, and retinal detachment.
  • Vanderveen et al observed strabismus is often variable and may improve by age 9 months.20
  • Follow-up by an ophthalmologist is required on a long-term basis.

Prognosis

  • The prognosis is predicted by the stage of retinopathy of prematurity. 
  • Patients who did not progress beyond stage I or stage II have a good prognosis. 
  • Patients with posterior zone I disease or stage II, IV, or V have a guarded prognosis for their vision.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The timing of examination and follow-up are important factors in the diagnosis and treatment of retinopathy of prematurity (ROP). If a patient misses an examination, it should be performed as soon as possible.
  • Ensuring that parents are aware of the significance of retinopathy of prematurity and appropriate follow-up is also important.
  • Patients can be discharged or transferred from the NICU while their retina is still immature. Most follow-up examinations by an ophthalmologist must occur within 2 weeks of discharge.
 


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

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Further Reading

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Keywords

retinopathy of prematurity, ROP, retrolental fibroplasia, retinal neovascularization, extremely low birth weight infants, ELBW, respiratory distress syndrome, RSD, bronchopulmonary dysplasia, BPD, sepsis, retinal hypoxia, tortuosity of vessels, maternal preeclampsia, pulmonary hemorrhage, visual impairment, blindness, myopia, amblyopia, strabismus, patent ductus arteriosus, intraventricular hemorrhage, visual impairment, blindness, supplemental oxygen, treatment, diagnosis

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Contributor Information and Disclosures

Author

KN Siva Subramanian, MD, Professor of Pediatrics and Obstetrics/Gynecology, Chief of Neonatal Perinatal Medicine, Director of Nurseries, Georgetown University Hospital
KN Siva Subramanian, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Nutrition, American Society for Parenteral and Enteral Nutrition, American Society of Law Medicine and Ethics, New York Academy of Sciences, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

Coauthor(s)

Monisha Bahri, MBBS, MD, Fellow in Neonatal/Perinatal Medicine, Department of Neonatology, Georgetown University Hospital
Monisha Bahri, MBBS, MD is a member of the following medical societies: American Academy of Pediatrics, Indian Academy of Pediatrics, and Medical Council of India
Disclosure: Nothing to disclose.

Gonzalo (Vike) Vicente, MD, FAAP, Consulting Ophthalmologist, Eye Doctors of Washington
Gonzalo (Vike) Vicente, MD, FAAP is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Oussama Itani, MD, FAAP, FACN, Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center
Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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