Screening for Retinopathy of Premature Infants
Release time : 03/09/2025 09:30:01
For parents of premature infants, it is important to pay attention to the physical indicators that contribute to the survival of their children. Parents of premature infants weighing less than 2 kilograms should promptly bring their children for screening for retinopathy of prematurity in order to prevent blindness due to this condition.
Premature infants with incomplete development of retinal vessels are prone to neovascularization and fibrosis in the retina, typically affecting both eyes. In mild cases, these conditions may resolve spontaneously; however, severe cases can lead to retinal detachment and blindness. However, with the advancement of screening techniques for premature infant retinopathy, early treatment can potentially cure the condition in babies.
There are many causes of retinopathy of prematurity, which are often associated with oxygen therapy, maternal anemia, and polyhydramnios. Early detection and treatment of retinopathy of prematurity can be curative, but if missed, the baby may eventually lose vision.
Premature infant retinopathy screening refers to the examination of the retina in premature infants and low birth weight infants, conducted from 4 to 6 weeks after birth or at 32 weeks of corrected gestational age, as an effective means to early detect retinopathy.
The incidence of retinopathy of prematurity is on the rise year by year. Retinopathy of prematurity is a morbid condition in premature infants, which includes retinal degeneration, retinal detachment, concomitant cataracts, secondary glaucoma and so on. In severe cases, it can lead to blindness.
If timely retinal screening is performed on premature infants, it can effectively prevent the occurrence of retinal lesions. Even if lesions occur, early detection and treatment can also cure them.
In the early stages (1-2), neonatal retinopathy can only be managed by regular follow-up. However, in stage 3, it is the optimal time for treatment and can be cured through laser therapy.
If missed for 3 stages, the disease can develop to advanced stage in 1-2 weeks, therefore, the treatment window is usually only short two weeks. And premature infants with retinopathy of prematurity have no abnormal appearance at 1-3 stages, when parents discover the children's eyes are abnormal, it is often already late, and often develop to blindness.
To ensure the health of the baby, mothers should take the baby to the hospital for premature infant retinopathy screening at an early stage.
Screening for Retinopathy of Prematurity in Preterm Infants With the advancement of neonatal medicine diagnosis and treatment levels in our country, the survival rate of preterm infants born at low gestational age and low birth weight has gradually increased. Retinopathy of prematurity has become one of the main causes that threaten the vision of preterm infants and may even lead to blindness.
Preterm infants have not yet fully developed their retinal vessels, making them more susceptible to the formation of new blood vessels and fibrosis in the retina. These conditions are often bilateral, with mild cases potentially self-healing, but severe cases can lead to retinal detachment and blindness.
However, with the advancement of screening technology for retinopathy of prematurity, early treatment can lead to recovery. So, how is the screening for this condition performed? The first fundus examination should generally be conducted between 4 to 6 weeks postnatally or at 32 weeks gestational age, depending on the results of the initial examination.
If there are no pathological changes in the eyes or only stage I changes, a follow-up examination can be scheduled every week until the retinal vessels reach the slit-like edges.
For lesions that have two stages, follow-up should be performed once a week. If the lesion improves during the follow-up, the examination can be conducted every two weeks until the lesion has completely disappeared.
In cases of Stage III disease, it is advisable to perform weekly follow-up examinations for 2 to 3 times.
When reaching the threshold level, it is necessary to perform cryotherapy or laser treatment within 72 hours after diagnosis. Mothers should pay attention to the treatment of retinopathy of preterm infants in time and reduce the damage to the vision of premature infants as much as possible.
Premature infant retinopathy of prematurity (PERP) is a condition that can lead to permanent blindness in children who are born prematurely. If detected between 4 and 6 weeks of age, the condition is treated with an excellent prognosis, as the eyesight of the child will be restored to normal once treatment is completed. However, only two weeks of treatment are available, making it known as the "window of time." Once this window closes, there is only a 10% chance of recovery.
Let's take a look at the symptoms of retinopathy of prematurity together.
1. Phase of Vascular Change: This is the early stage observed in the course of this disease, with both arterioles and venules being tortuously dilated. Venous diameter sometimes exceeds three to four times normal, and capillary pedicles at the periphery of the retina are visible as brush-like vessels.
2. Retinal Stage: As the condition progresses, the vitreous body becomes cloudy, and the fundus appears more hazy than before. The retina exhibits an increased number of neovascularizations, predominantly located near the equatorial region, but also present in the regions before or after the equatorial pole. This area of the retina is prominently elevated with capillaries advancing over its surface, often accompanied by varying degrees of retinal hemorrhage.
3. Early Proliferative Stage: The aforementioned localized retinal protrusions exhibit proliferating blood vessel bundles, which extend into the vitreous and cause peripheral (most cases) or posterior pole (few cases) retinal detachment in the early stages of proliferation.
4. Moderate proliferative stage: The separation area extends to more than half of the retina.
5. Extensive Proliferation Stage: Retina in total dislocation.
At times, a large amount of blood can be observed inside the glass chamber.
What causes retinopathy of prematurity? Retinopathy of prematurity is proliferative retinopathy in premature or low-birth-weight infants. Mild cases may leave residual scars, while severe cases result in irreversible proliferation in both eyes, eventually leading to complete blindness.
The incidence rate of retinopathy in preterm infants is approximately 15~30%, and all patients are premature low birth weight infants.
What causes retinopathy of prematurity? 1. All cases have a history of excessive oxygen administration in the incubator, with longer durations of exposure associated with higher incidence rates. There is also a risk for retinopathy of prematurity without any history of oxygen administration, which can be caused by rapid increases in fetal hemoglobin oxygen saturation and the transition from fetal to neonatal oxygen partial pressures, among other factors.
Additionally, maternal anemia and polyhydramnios are also factors contributing to retinopathy of prematurity.
2. In the early stages of fetal development, retinal vascularization occurs, with the vitreous and choroid supplying nutrients to the embryonic retina. At a stage of 100mm in embryonic size, the vitreous blood vessels penetrate through the ora serrata, while also extending small branches from the ora serrata into the peripheral retina.
Initially, they are only observed in the nerve fiber layer, and later reach the deep layers. In a normal fetus at 6 to 7 months of gestation, there is significant vascular proliferation, while premature infants have not yet developed their retinas fully and the peripheral parts are the least mature.
3. In environments with high oxygen levels, the retinal vessels constrict and obstruct, causing local ischemia and hypoxia, leading to abnormal proliferation of the retinal vessels, thereby inducing a series of changes such as exudation, hemorrhage, and sclerosis.
Abnormally proliferated retinal vessels penetrate the internal limiting membrane and extend towards the retinal surface, eventually extending into the vitreous body. Due to the vascularization of the exuded vitreous, a connective tissue membrane forms behind the lens, which may also lead to retinal detachment.
Prevention of Retinopathy of Premature Infants: Retinopathy of Premature Infants is a disease caused by abnormal proliferation of retinal blood vessels in newborns, which is related to oxygen therapy, maternal anemia and polyhydramnios.
Although people have begun to recognize this disease, there are still families and even non-specialist doctors who lack a thorough understanding of it. This is why many premature infants miss the optimal treatment window due to delays in their examinations.
Then how to prevent retinopathy of prematurity? Strict restriction of oxygen for preterm infants is the only effective prevention measure, except in case of cyanosis with life-threatening condition, 40% oxygen can be given for short time.
Furthermore, the early use of large doses of vitamins may also have a certain preventive effect. Early detection and timely implementation of cryotherapy or laser photocoagulation has been reported to successfully prevent the further worsening of lesions.
Additionally, to prevent the occurrence of secondary glaucoma in premature infants with retinopathy of prematurity, it is essential to frequently dilate pupils during active phases to avoid posterior synechiae.
In conclusion, the complications of premature infant retinopathy should be given high priority and active preventive measures should be taken.
The medical information in this article is for reference only.
In case of discomfort, it is recommended to seek medical attention immediately. The diagnosis and treatment should be based on the clinical examinations conducted by a doctor in person.