Symptoms of retinopathy in premature infants
Release time : 03/07/2025 09:30:01
Retinopathy of prematurity is one of the common diseases in premature infants.
Once preterm infant retinopathy of prematurity occurs, it progresses rapidly, so it is necessary to provide timely observation for preterm infants.
The symptoms of retinopathy in preterm infants are extremely specific and vary from stage to stage.
What exactly is Retinopathy of Prematurity? What are the symptoms of Retinopathy of Prematurity in very premature infants? The condition is commonly seen in very premature infants, typically occurring between 3 to 6 weeks after birth. Clinically, Retinopathy of Prematurity is divided into active and fibrous membrane formation stages.
The premature infants with retinopathy also have a very detailed classification, so we can judge the condition by these clinical manifestations. In fact, the premature infants with retinopathy is divided into active phase and fibrous membrane formation phase, and there are strict divisions between them.
The course of neonatal retinopathy of prematurity is generally 3 to 5 months, and it usually goes through five stages. It's also possible that the process will stop at stage three, four or five and enter the stage of fibrous membrane formation.
Now let's take a look at the primary symptoms of these two periods.
Activity Phase I: Vascular Change Stage: This stage is the initial manifestation of retinopathy of prematurity observed during the early course of the disease.
Both arteries and veins are tortuously dilated.
Vein diameter is sometimes more than 3 to 4 times the normal diameter.
The peripheral retinal vessels are observed to have fine, bristly capillaries.
2. Retinal Stage: As the pathology progresses, the vitreous appears cloudy and the fundus appears more hazy than before.
Retinal neovascularization is increased, mostly located near the equator, but can also be seen in the equatorial regions anterior or posterior to it. The region of the retina appears significantly elevated, with capillary vessels proliferating on its surface. This often accompanies varying degrees of retinal hemorrhage.
3. Early Proliferation Stage: The above-mentioned localized retinal protrusions exhibit proliferating vessel bundles and develop into the vitreous, causing a small area of retinal detachment in the periphery (mostly) or posterior pole (few) of the fundus.
4. Moderate proliferative phase: The separation area extends to more than half of the retina.
5. Extremely Proliferative Stage: Retinal Total Detachment.
Sometimes, large amounts of blood can be observed within the glass cavity.
Fibrovascular Stage: In cases where the activity phase does not subside on its own, fibrous membranes eventually form as a result of scarring. Depending on the severity, these can be classified into grades 1 to 5: Grade I: Retinal vessels are narrow and there is gray-white opacification in the periphery of the retina, with small irregularly shaped pigmented spots scattered throughout the retina. There is also opacification in the vitreous near the retina, often accompanied by myopia.
II. The peripheral vascular arcs of the retina are involved with a necrotic mass, and the disc and vessels in the affected area are displaced toward one side. There is a pigmented band at the edge of the opposite disc, and there is a loss of color in the disc.
III degree: the retina is stretched by fibrous membrane and forms one or several folds.
Each wrinkle is connected with a membranous nodule at the periphery of the retina.
The retinal vessels do not radiate along this fold, unlike congenital retinal folds.
IVth degree: The crystalline lens is visible behind the retina, with a fibrous membrane or part of the retina that has undergone scarring, obscuring the pupil.
V. Grade: The crystal is completely covered by a fibrous membrane or the sclera, or has been detached from the retina.
During mydriasis examination, a saw-toothed extension of the ciliary processes can be observed around the periphery of the pupil.
The anterior chamber is very shallow, and there is often adhesions between the iris anteriorly and posteriorly.
Secondary glaucoma or extensive iridial synechiae may lead to corneal opacification, a smaller and retracted eyeball compared to normal.
What is Premature Rupture of the Retinal Vessel? Premature rupture of the retinal vessel (ROP) typically occurs between 3 and 6 weeks after birth, commonly among premature infants. According to data, ROP refers to the unvascularized retina of preterm infants undergoing fibroblastic proliferation and contraction, leading to traction retinal detachment and blindness due to the process.
It was previously known as Terry syndrome or lenticonus, but the latter only reflects the late manifestation of this disease.
The incidence rate of preterm labor and low birth weight infants can reach 60% to 80%.
Generally speaking, the progression of Retinopathy of Premature Babies is rapid, so it's important to closely monitor the infant's condition and avoid missing the optimal treatment window.
However, premature infants with retinopathy of prematurity are generally more susceptible to visual impairment. Therefore, the best approach is to limit oxygen use for these infants, which is the sole effective prevention measure.
The cause of retinopathy of prematurity in premature infants is common, and if not treated in time, it can have a significant impact on the premature infant's condition, even affecting their vision.
It is well known that premature infants with retinopathy of prematurity are generally classified into five stages, with varying degrees of effectiveness in treatment depending on the stage. So, what causes retinopathy of prematurity? Why do premature infants often develop retinopathy of prematurity? The underlying cause of retinopathy of prematurity is believed to be due to the retina being unvascularized and its response to oxygen leading to vasoconstriction and proliferation of blood vessels.
Normal retinal vessels develop to the nasal side edge at about 36 weeks gestation and to the temporal side edge at about 40 weeks gestation.
During this period, exposure to high concentrations of oxygen can cause damage to capillary endothelial cells, leading to vascular obstruction. This stimulates the proliferation of fibrotic blood vessels, making it easy for premature infants to develop retinopathy.
Therefore, the only effective prevention is to limit oxygen use in infants.
How to Screen for Retinopathy of Premature Infants? We all know that retinopathy of prematurity often occurs in premature infants, but many premature infants do not exhibit stress responses to this condition. Therefore, physicians must conduct screenings. Since retinopathy of prematurity is mostly observed in premature infants, it is often necessary to inquire about any history of excessive oxygen exposure within the incubator.
In addition, fundus examinations should be conducted on infants. The first examination is advocated for preterm infants with gestational age <32 weeks and birth weight <1500g, starting 4 weeks after birth.
In the absence of any pathological changes in both eyes or only stage 1 changes: Repeat examinations every other week until ROP regresses and retinal vessels reach the serratus margin.
Stage II lesions or prethreshold lesions or Rush lesions: one weekly follow-up.
ROP decrease, check every 2 weeks until the lesion completely regresses.
Third-stage lesion: Repeat examinations every 2 to 3 weeks.
And the examination method is not difficult, half an hour before the examination, use medoll eye drops to fully dilate the pupils.
During the examination, a drop of benzocaine eye ointment is used for topical anesthesia on the surface of the eyeball. The upper eyelid is separated by an eyelid speculum and an indirect ophthalmoscope with a dioptric lens of 20 to 30D is used for fundus examination.
Monitor vital signs simultaneously to prevent bradycardia caused by the phenomenon of eye-heart reflex.
Upon examination: It is necessary to abstain from food for 30 minutes to 2 hours before eating. The period of abstinence is longer for patients with lighter weights, but it is crucial to prevent hypoglycemia.
Doppler ultrasound: Adjust the gain to maximum, apply the 8-point position examination method for a comprehensive examination of the vitreous.
Then, the gain is attenuated to a normal range, and the morphology of the lesion is observed.
How should premature neonatal retinopathy be treated? Although premature neonatal retinopathy is a common condition in preterm infants, it is important to pay attention to this condition. The progression of premature neonatal retinopathy is rapid, and the window for effective treatment is narrow. Therefore, it is crucial to conduct timely examinations for preterm infants born within 37 weeks and for high-risk infants to undergo weekly checks.
During the 2nd to 3rd stage, laser or cryotherapy can be performed for coagulating non-vascular areas.
During the 4th to 5th phase, vitreoretinal surgery was performed to remove proliferating fibrovascular tissue and photocoagulation was also carried out to save vision.
Moreover, it is essential to continuously monitor the condition after treatment and prevent any further deterioration of retinopathy in premature infants.
In fact, when facing the issue of retinopathy of prematurity, it is generally necessary to pay special attention. After all, retinopathy of prematurity poses a threat to vision, so it is important to invest extra effort in this area from the beginning, especially not to casually place premature infants in oxygen tanks.
Can premature infant retinopathy be cured? Premature infant retinopathy is common in premature infants, and many mothers worry that it may leave a lasting impact on their children.
Can premature infants' retinopathy of prematurity be cured? In fact, premature infants' retinopathy of prematurity can generally be cured. However, since premature infants' retinopathy of prematurity is a condition that cannot be "set back," the earlier it is diagnosed, the better the treatment outcome for premature infants' retinopathy of prematurity.
The severity of the inflammatory process and extent of fibrosis vary with the stage of disease.
Those who can stop the activity during the first and second phases of an active period without significant vision impairment.
Although there is still a fibrous membrane residue, if it does not involve the macula, it can preserve good vision.
When the fibrous membrane is formed to 4-5 degrees, vision is severely impaired.
Therefore, to treat retinopathy of prematurity, it is best to pay close attention to premature infants in the past and promptly recognize the condition for timely treatment.
The medical information provided in this text is for reference only.
If you experience discomfort, it is recommended to seek medical attention immediately for accurate diagnosis and treatment.