Retinopathy of Prematurity Workup

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

Other Tests

Ophthalmologic evaluation in retinopathy of prematurity (ROP)

Record the vascular maturity (how far out the vessels have grown), as indicated by zone, stage of disease, and the presence or absence of plus disease or preplus disease.

Quantify the extent of retinopathy of prematurity on the basis of number and contiguity of clock hours in which the disease is present in the retina.

Some centers are also experimenting by taking retinal fundus photographs and having an off-site ophthalmologist evaluate the photos.

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Staging

The international classification of retinopathy of prematurity (ICROP) describes 5 stages of retinopathy of prematurity, as follows: [14]

  • Stage I is characterized by a line of demarcation. Extra vessels can be seen growing at the leading edge of the retinal vasculature. The line of demarcation separates the vascularized portion of the retina from the anteriorly positioned avascular retina.
  • Stage II is characterized by an elevated ridge, rather than a flat demarcation line. Neovascularization may be present but is posterior to the ridge.
  • Stage III refers to extraretinal neovascularization or vessels that grow onto the ridge and then into the vitreous toward the examiner.
  • Stage IV refers to partial retinal detachment.
  • Stage V is total retinal detachment.
  • Some ophthalmologists describe an immature or avascular retina as Stage 0 retinopathy of prematurity.

Plus disease refers to severe tortuosity of vessels. Preplus disease is defined as vascular abnormalities of the posterior pole characterized by more arterial tortuosity and more venous dilatation than normal but not severe enough to be classified as plus disease. Rapidly progressing plus disease is sometimes referred to as Rush disease.

Zones of disease

Zone I is the innermost area of the retina surrounding the macula (see the image below).

Zone I retinopathy of prematurity. Zone I retinopathy of prematurity.

Zone II is the middle third of the retina, nasally extending to the edge of the retina (see the image below).

Zone II retinopathy of prematurity. Zone II retinopathy of prematurity.

Zone III is the most peripheral area of the retina on the temporal side (see the image below).

Zone III retinopathy of prematurity. Zone III retinopathy of prematurity.

Types

As of the publication of the Early Treatment for Retinopathy of Prematurity (ETROP) study, more ophthalmologist are describing eyes with retinopathy of prematurity into 2 types (see the image below):

Treatment guidelines, according to the Early Treat Treatment guidelines, according to the Early Treatment for Retinopathy of Prematurity (ET-ROP) study.

Type 1 requires treatment and includes the following:

  • Eyes with zone I, stage III retinopathy of prematurity without plus disease or
  • Eyes with zone II, stage II or stage III retinopathy of prematurity with plus disease

Type 2 requires observation and includes the following:

  • Eyes with zone I, stage I or stage III retinopathy of prematurity without plus disease or
  • Eyes with zone II, stage III retinopathy of prematurity without plus disease
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