Retinopathy of Prematurity, Laser Treatment

ExitCare ImageRetinopathy of Prematurity (ROP) is a condition that can develop in the eyes of premature babies. New blood vessels can overgrow in the retina (the tissue that captures images in the back of the inside of the eye). This process of blood vessel overgrowth is called ROP. If the blood vessels grow too much, the retina may deform or detach. ROP can lead to loss of vision. The amount of vision loss, if any, is determined by the amount of damage to the eye.

There are no symptoms of ROP. All premature babies born less than 32 weeks of development (gestation) should be looked at regularly for ROP by an eye doctor (ophthalmologist). Babies born after 32 weeks, but who had major clinical problems, should be also examined for ROP.

Mild ROP does not usually need treatment. It often either stops or improves. However, some mild disease can worsen into severe disease in the newborn period. Severe forms of ROP need treatment.

When treatment is done depends on the type of ROP and the location of the disease in the retina.

RISKS AND COMPLICATIONS

Like any procedure, there are possible risks. These include:

  • Brief periods of slowed heartbeat (bradycardia) or drop in oxygen during the procedure. These are easily handled by stopping the procedure for a moment.

  • Corneal haze or later development of areas in the cornea that are not clear (cataracts).

  • Glaucoma. Raised pressure within the eye. This can show up later.

  • Bleeding inside the treated eye.

  • Iris atrophy. This is partial shrinkage of the colored part of the eye.

  • Hypotony. This is low pressure in the eye that may lead to damage to the cornea or increase the risk of cataract formation.

  • Detached retina. The retina is pulled off the back of the eye. This means the nerves cannot deliver images to the brain.

Even with successful treatment, other factors may lead to less than normal vision in premature infants. With or without ROP, there can be vision loss due to:

  • The brain ignoring vision signals (‘Lazy eye'/ amblyopia).

  • Eyes that do not line up together (strabismus).

  • Damage to the brain from bleeding and poor oxygenation in the neonatal period.

  • Myopia or other vision problems needing glasses or contacts.

BEFORE THE PROCEDURE

  • Some babies may need medicines to calm them (sedation).

  • Sometimes help with breathing (ventilation) before and during the procedure is needed.

  • If your baby was receiving oxygen before the procedure, this may need to be temporarily increased during the procedure.

  • Eye drops will be given to make the pupils larger (dilate).

PROCEDURE

There are 2 different procedures for treating ROP: laser phototherapy (most common) and cryotherapy (freezing).

In laser phototherapy, the eye surgeon directs a laser beam through the pupil. The beam destroys many tiny areas of the peripheral retina. This prevents the ROP from getting worse. This procedure can be done in the nursery with portable equipment.

Normally, only one treatment is needed. The eye doctor will continue to check your baby's eyes. In some cases, further treatments may be necessary.

AFTER THE PROCEDURE

Treatment may cause your baby's eyes to become a little red. This will go away in a few days. The nurses may put special drops and ointment into your baby's eyes to help them heal. Because of the possibility of delayed eye problems, every premature infant should be watched for vision problems.