Retinopathy of Prematurity Follow-up

Updated: Feb 28, 2015
  • Author: KN Siva Subramanian, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Follow-up

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. [10] 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.

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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.

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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. [27]

Recent studies have shown that maintaining oxygen saturation values by pulse oximeter (SpO2) at 83-93% decreases the incidence of threshold retinopathy of prematurity. [28, 29]

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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. [25]

Follow-up by an ophthalmologist is required on a long-term basis.

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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 III, IV, or V have a guarded prognosis for their vision.

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Patient Education

Ophthalmic Mutual Insurance Company has useful sample forms available online for doctors and families.

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