Retinopathy of Prematurity (ROP)
Description Time of screening Medicine treatment Referral ICD-10 code: H35.1 DESCRIPTION ROP is a potentially preventable cause of blindness. ROP is classified into five stages, ranging from mild (stage I) to severe (stage V): Stage I – Mildly abnormal blood vessel growth. Many children who develop stage I improve with no treatment and eventually develop normal vision. The disease res
Description
Time of screening
Medicine treatment
Referral
ICD-10 code: H35.1
DESCRIPTION
ROP is a potentially preventable cause of blindness.
ROP is classified into five stages, ranging from mild (stage I) to severe (stage V):
Stage I – Mildly abnormal blood vessel growth.
- Many children who develop stage I improve with no treatment and eventually develop normal vision.
- The disease resolves on its own without further progression.
Stage II – Moderately abnormal blood vessel growth.
- Many children who develop stage II improve with no treatment and eventually develop normal vision.
- The disease resolves on its own without further progression.
Stage III – Severely abnormal blood vessel growth.
- The abnormal blood vessels grow toward the centre of the eye instead of following their normal growth pattern along the surface of the retina.
- Some infants who develop stage III improve with no treatment and eventually develop normal vision.
- However, when infants have a certain degree of stage III and ‘plus disease’ develops, treatment is considered.
- ‘Plus disease’ means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease.
- Treatment at this point has a good chance of preventing retinal detachment.
Stage IV – Partially detached retina.
- Traction, from the scar produced by bleeding and abnormal vessels, pulls the retina away from the wall of the eye.
Stage V – Completely detached retina and the end-stage of the disease.
- If the eye is left alone at this stage, the baby can have severe visual impairment and even blindness.
TIMING OF SCREENING
- Screening should be done at 4 –6 weeks’ chronological age or 31–33 weeks’ post conception age (whichever comes later).
MEDICINE TREATMENT
Dilation of the pupils for ROP screening by ophthalmologist:
- Cyclopentolate 0.5%/phenylephrine 2.5%, ophthalmic drops, instil 1 drop every 5 minutes for 3 doses 1 hour before examination.
REFERRAL
- All neonates weighing less than 1250 g OR ≤ 30 weeks’ gestational age OR those 1250 g–1500 g with high risk for ROP (on prolonged oxygen) should be screened for ROP by ophthalmological examination.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 16: Eye Conditions, 16.8 Retinopathy Of Prematurity (ROP)