Dragged disc There is temporal dragging of the disc and the blood vessels. The blood vessels are straightened. Look for: strabismus high myopia and previous retinal detachment operation which are common in patient with retinopathy of prematurity. Do not diagnose ROP until you have examined the other eye and obtain a history of prematurity. Questions: 1. What is the differential diagnosis of a dragged disc?Answer retinopathy of prematurity familial exudative vitreoretinopathy peripheral toxocaral granuloma incotinential pigmenti (Bloch-Sulzberger syndrome) combined hamartoma of the retina and RPE 2. Who are at risk of retinopathy of prematurity? Answer There are several known factors for the development of retinopathy of prematurity. ROP seems to be a multifactorial disease, and many different conditions or stimuli probably contribute to the risk of developing this problem. GESTATIONAL AGE AND LOW BIRTH WEIGHT The lower an infant's birthweight and gestational age at birth, the more likely they are to develop ROP, and the more likely it is to require treatment. The CRYO-ROP group found that 47% of infants with a birth weight between 1000 and 1250 grams had some degree of ROP, as compared with 90% of infants with a birthweight less than 750 grams. The percentage of neonates with stage 3 ROP was 8% for the 1000-1250 gram group and 37% for the <750 gram group. A similar pattern was seen for gestational age, with ROP occurring in 83% of infants born at less than 28 weeks gestation and in 30% of infants born at more than 31 weeks gestation. SUPPLEMENTAL OXYGEN In the ROP epidemic of the 1950's, oxygen was shown to be a major cause for the development of the disease. It was discovered that infants on higher levels of supplemental oxygen were more likely to have ROP, but infants on lower levels of oxygen were more likely to die or have systemic complications of low oxygen. As arterial blood oxygen monitoring became available, it was possible to monitor the blood oxygen levels more precisely. With today's trancutaneous blood oxygen monitoring, the use of oxygen can be very carefully titrated to minimize the risk of ROP while avoiding the systemic complications of having too little oxygen. Ironically, with the increasing skill and technology available in SCBUs, we are seeing an increase in ROP, since more tiny babies are surviving that would have otherwise have died. Although supplemental oxygen is a significant risk factor for ROP, the careful control of oxygen levels in modern SBCUs probably reduces this risk as low as possible without compromising the infant's medical status. VITAMIN E DEFICIENCY Because of its antioxidant properties, vitamin E has been evaluated as a possible treatment or prophylaxis for ROP. Several controlled clinical trials have been performed, but the results are difficult to interpret. In 1986, the Institute of Medicine published a report in which they stated that there was no conclusive evidence of either benefit or harm from vitamin E administration. They did feel, however, that there was enough evidence to support treatment for vitamin E deficiency in premature infants. RACE There are some racial differences in the risk for developing ROP. In the CRYO-ROP study, black infants were found to be less likely to develop ROP and less likely to go on to threshold ROP than white infants. Other racial groups appeared to have a similar risk of ROP as compared with white infants. 3. How is retinopathy of prematurity classified? Answer The International Classification of ROP describe the finding of ROP according to the locations and the severity (stages). For location: zone 1 = circumferential area around the optic nerve with a radius twice the distance from the optic nerve to the fovea zone II = extends from the edge of zone 1 peripherally to a point tangential to the nasal ora serrata and around to an area near the temporal anatomic equator zone III = temporal crescent not covered by zone 2 For severity: Stage 1 = demarcation line with straightening of the peripheral vessels Stage 2 = elevated ridge with volume which extends out of the plane of the retina Stage 3 = ridge with neovascularisation extending off the retina into the vitreous Stage 4 = subtotal retinal detachment a = extrafoveal b = retinal detachment including fovea Stage 5 = total retinal detachment with funnel configuration. 4. What is 'plus disease'? Answer It is seen in ROP and is associated with an increased chance of severe ROP. There is pupillary rigidity and iris vascular engorgement anteriorly and posteriorly, there is venous dilatation and arterial tortuosity. 5. What is threshold disease? Answer It is the presence of at least 5 contiguous or 8 cumulative 300 sectors (clock hours) of stage 3 ROP in zone I or II in the presence of plus disease. Return to the main page
Look for:
Do not diagnose ROP until you have examined the other eye and obtain a history of prematurity.
Questions:
1. What is the differential diagnosis of a dragged disc?Answer retinopathy of prematurity familial exudative vitreoretinopathy peripheral toxocaral granuloma incotinential pigmenti (Bloch-Sulzberger syndrome) combined hamartoma of the retina and RPE
2. Who are at risk of retinopathy of prematurity?
There are several known factors for the development of retinopathy of prematurity. ROP seems to be a multifactorial disease, and many different conditions or stimuli probably contribute to the risk of developing this problem. GESTATIONAL AGE AND LOW BIRTH WEIGHT The lower an infant's birthweight and gestational age at birth, the more likely they are to develop ROP, and the more likely it is to require treatment. The CRYO-ROP group found that 47% of infants with a birth weight between 1000 and 1250 grams had some degree of ROP, as compared with 90% of infants with a birthweight less than 750 grams. The percentage of neonates with stage 3 ROP was 8% for the 1000-1250 gram group and 37% for the <750 gram group. A similar pattern was seen for gestational age, with ROP occurring in 83% of infants born at less than 28 weeks gestation and in 30% of infants born at more than 31 weeks gestation. SUPPLEMENTAL OXYGEN In the ROP epidemic of the 1950's, oxygen was shown to be a major cause for the development of the disease. It was discovered that infants on higher levels of supplemental oxygen were more likely to have ROP, but infants on lower levels of oxygen were more likely to die or have systemic complications of low oxygen. As arterial blood oxygen monitoring became available, it was possible to monitor the blood oxygen levels more precisely. With today's trancutaneous blood oxygen monitoring, the use of oxygen can be very carefully titrated to minimize the risk of ROP while avoiding the systemic complications of having too little oxygen. Ironically, with the increasing skill and technology available in SCBUs, we are seeing an increase in ROP, since more tiny babies are surviving that would have otherwise have died. Although supplemental oxygen is a significant risk factor for ROP, the careful control of oxygen levels in modern SBCUs probably reduces this risk as low as possible without compromising the infant's medical status. VITAMIN E DEFICIENCY Because of its antioxidant properties, vitamin E has been evaluated as a possible treatment or prophylaxis for ROP. Several controlled clinical trials have been performed, but the results are difficult to interpret. In 1986, the Institute of Medicine published a report in which they stated that there was no conclusive evidence of either benefit or harm from vitamin E administration. They did feel, however, that there was enough evidence to support treatment for vitamin E deficiency in premature infants. RACE There are some racial differences in the risk for developing ROP. In the CRYO-ROP study, black infants were found to be less likely to develop ROP and less likely to go on to threshold ROP than white infants. Other racial groups appeared to have a similar risk of ROP as compared with white infants.
GESTATIONAL AGE AND LOW BIRTH WEIGHT The lower an infant's birthweight and gestational age at birth, the more likely they are to develop ROP, and the more likely it is to require treatment. The CRYO-ROP group found that 47% of infants with a birth weight between 1000 and 1250 grams had some degree of ROP, as compared with 90% of infants with a birthweight less than 750 grams. The percentage of neonates with stage 3 ROP was 8% for the 1000-1250 gram group and 37% for the <750 gram group. A similar pattern was seen for gestational age, with ROP occurring in 83% of infants born at less than 28 weeks gestation and in 30% of infants born at more than 31 weeks gestation. SUPPLEMENTAL OXYGEN In the ROP epidemic of the 1950's, oxygen was shown to be a major cause for the development of the disease. It was discovered that infants on higher levels of supplemental oxygen were more likely to have ROP, but infants on lower levels of oxygen were more likely to die or have systemic complications of low oxygen. As arterial blood oxygen monitoring became available, it was possible to monitor the blood oxygen levels more precisely. With today's trancutaneous blood oxygen monitoring, the use of oxygen can be very carefully titrated to minimize the risk of ROP while avoiding the systemic complications of having too little oxygen. Ironically, with the increasing skill and technology available in SCBUs, we are seeing an increase in ROP, since more tiny babies are surviving that would have otherwise have died. Although supplemental oxygen is a significant risk factor for ROP, the careful control of oxygen levels in modern SBCUs probably reduces this risk as low as possible without compromising the infant's medical status. VITAMIN E DEFICIENCY Because of its antioxidant properties, vitamin E has been evaluated as a possible treatment or prophylaxis for ROP. Several controlled clinical trials have been performed, but the results are difficult to interpret. In 1986, the Institute of Medicine published a report in which they stated that there was no conclusive evidence of either benefit or harm from vitamin E administration. They did feel, however, that there was enough evidence to support treatment for vitamin E deficiency in premature infants. RACE There are some racial differences in the risk for developing ROP. In the CRYO-ROP study, black infants were found to be less likely to develop ROP and less likely to go on to threshold ROP than white infants. Other racial groups appeared to have a similar risk of ROP as compared with white infants.
SUPPLEMENTAL OXYGEN In the ROP epidemic of the 1950's, oxygen was shown to be a major cause for the development of the disease. It was discovered that infants on higher levels of supplemental oxygen were more likely to have ROP, but infants on lower levels of oxygen were more likely to die or have systemic complications of low oxygen. As arterial blood oxygen monitoring became available, it was possible to monitor the blood oxygen levels more precisely. With today's trancutaneous blood oxygen monitoring, the use of oxygen can be very carefully titrated to minimize the risk of ROP while avoiding the systemic complications of having too little oxygen. Ironically, with the increasing skill and technology available in SCBUs, we are seeing an increase in ROP, since more tiny babies are surviving that would have otherwise have died. Although supplemental oxygen is a significant risk factor for ROP, the careful control of oxygen levels in modern SBCUs probably reduces this risk as low as possible without compromising the infant's medical status. VITAMIN E DEFICIENCY Because of its antioxidant properties, vitamin E has been evaluated as a possible treatment or prophylaxis for ROP. Several controlled clinical trials have been performed, but the results are difficult to interpret. In 1986, the Institute of Medicine published a report in which they stated that there was no conclusive evidence of either benefit or harm from vitamin E administration. They did feel, however, that there was enough evidence to support treatment for vitamin E deficiency in premature infants. RACE There are some racial differences in the risk for developing ROP. In the CRYO-ROP study, black infants were found to be less likely to develop ROP and less likely to go on to threshold ROP than white infants. Other racial groups appeared to have a similar risk of ROP as compared with white infants.
VITAMIN E DEFICIENCY Because of its antioxidant properties, vitamin E has been evaluated as a possible treatment or prophylaxis for ROP. Several controlled clinical trials have been performed, but the results are difficult to interpret. In 1986, the Institute of Medicine published a report in which they stated that there was no conclusive evidence of either benefit or harm from vitamin E administration. They did feel, however, that there was enough evidence to support treatment for vitamin E deficiency in premature infants. RACE There are some racial differences in the risk for developing ROP. In the CRYO-ROP study, black infants were found to be less likely to develop ROP and less likely to go on to threshold ROP than white infants. Other racial groups appeared to have a similar risk of ROP as compared with white infants.
RACE There are some racial differences in the risk for developing ROP. In the CRYO-ROP study, black infants were found to be less likely to develop ROP and less likely to go on to threshold ROP than white infants. Other racial groups appeared to have a similar risk of ROP as compared with white infants.
3. How is retinopathy of prematurity classified?
4. What is 'plus disease'?
5. What is threshold disease?
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