Retinopathy of prematurity
Retrolental fibroplasia
The retinopathy of prematurity (RPM; Synonyms: retrolental fibroplasia ( RLF ) or retinopathy of prematurity, retinopathy of prematurity (ROP ), Terry 's syndrome) is also counted among the Pseudogliomen because of the possibility of confusion with retinoblastoma and is a retinal disease in preterm infants. Cause is the incomplete maturation ( vascular supply ) of the outer retina at birth in combination with mechanical ventilation in the first days of life.
Cause
In the fetus the outer retina is not fully supplied with vessels. During pregnancy, there is in the retina of a relative lack of oxygen (hypoxia). This is a stimulus for the sprouting of retinal vessels in the outer retina, which is usually completed at the time of birth.
Not applicable for the still incomplete supplied with vessels retina of preterm these hypoxia after birth (especially for ventilation), remains among the more Gefäßausreifung; it comes to the formation of so-called strips and demarcation of the border between vascularized and nichtvaskularisierter retina. 6 to 8 weeks after birth may lead to an excessive and uncontrolled angiogenesis. This is done by growth factors ( for example VEGF). The vessels can remodel in the further course to fibrovascular strands, which can lead to retinal detachment ( tractional ) and blindness.
Occurrence
The incidence in premature infants (< 30 weeks of gestation ) with a birth weight < 1500 g is between 16-56 %. The disease occurs between the 32th and 45th week after fertilization. 90% of children show a spontaneous regression of the changes. The recovery takes about 15 weeks. The most important risk factor is the development level of the child at birth, next to it is an artificial respiration or oxygen by adding an important risk factor.
Classification
Localization
The first classification describes the presence of the typical stages of change in terms of their localization in the retina, the optic disc is used as a reference point.
- Zone I: circle around the optic disc with the double papilla - fovea distance.
- Zone II: field peripheral to zone I to a circle around the optic disc, which includes the nasal ora serrata.
- Zone III: Rest of peripheral retinal district.
Staging
The pathological changes are divided into different stages:
- Stage 1: thin, sharply defined line of demarcation between peripheral avascular and vascularized central retina.
- Stage 2: increasing expansion of the demarcation line in width and height. These so-called bar can be whitish or reddish. Retinal vessels can sprout one in the bar.
- Stage 3: additional vascular neoplasms with extension into the vitreous.
- Stage 4a: tractional detachment of the peripheral retina, macula fitting.
- Stage 4b: tractional detachment of the peripheral retina, macular lifted.
- Stage 5: total tractional retinal detachment with formation of a central retinal funnel. Depending on the configuration of the funnel can be made more sub-groupings.
Additional Features
- Plus sign: tortuosity of the vessels due to the increased shunt volume, vitreous opacity, increased iris vascular pattern, weak pupil response, retinal and vitreous hemorrhage.
- Threshold Disease occurs when 5 contiguous or 8 noncontiguous hours are affected by preretinal proliferations ( medium weight stage 3) and at the same time the vessels at the posterior pole pathologically enlarged and tortuous are ( Pluszeichen.
Treatment
The treatment is based on the present stage of the disease and localization that are tracked through regular eye examination. In early stages, a Spontanabheilung to wait ( under close-knit ophthalmologic controls). In later stages, an obliteration of the non-supplied vessels retina by photocoagulation or ice treatment is necessary. A detached retina often must be treated by vitrectomy. Even later in life, the risk is increased for a retinal detachment.