• Retinal vascularization begins around the optic disc at week 16 and ends at week 36 on the nasal side and week 40 on the temporal side. Vascular endothelial growth factor (VEGF) is responsible for retinal vascularization. If the baby is born before retinal vascularization is completed, and in the presence of one or more of the risk factors listed below, VEGF secretion is impaired and abnormal vascularization occurs. Retinopathy develops due to the bleeding or mass effect of these abnormal vascular structures.
• Its incidence is inversely proportional to the gestational age. Severe forms lead to total retinal detachment and blindness.
Major factors involved in the pathogenesis of ROP
• Prematurity (most important)
• Low birth weight
• Hyperoxia
• Deficiency of vitamins E and A
• Respiratory distress
• Excessive lighting
• Apnea
• Hypercapnia
• bradycardia
• Intraventricular bleeding
• Heart diseases
• Sepsis
• Infections
• Exchange transfusion
• Hyperglycemia
• Recurrent apnea
• Acidosis
• IGF-1 low
• Anemia
• Inadequacy of the premature care unit
• Transfusion
• Postnatal low weight gain
Retinopathy of prematurity is divided into 5 stages:
- Stages 1 and 2 are mild retinopathy. It fixes itself.
- Stage 3 is the threshold stage. Stage 3 and above cases caught in ROP scans should be treated with laser or cryotherapy within 72 hours.
- Stages 4 and 5 have retinal detachment. The risk of blindness is very high. A high proportion of these cases go to vitrectomy.
• Anti-VEGF (bevacizumab) therapy is also being tried, although its use in newborns has not yet been approved.
