The health of our tiny little ones who say hello to life early is the most sensitive and prioritized issue in the world for every parent. The not-yet-fully matured bodies of premature babies need a lot of medical support and close monitoring while adapting to the outside world. One of the most vital risks that should not be overlooked during this critical process is Retinopathy of Prematurity (ROP), which can lead to lifelong permanent vision loss.
What is Retinopathy of Prematurity (ROP)?
In a normal pregnancy process, vascular development in the baby's eye begins in the womb at approximately the 16th week and continues until birth (around the 40th week), reaching the far edges of the retina (the nerve layer of the eye). However, when a baby is born prematurely, this normal vascular development process is interrupted. The eye tries to continue its development in an external environment (in the neonatal intensive care unit) to meet its oxygen and nutrient needs.
Retinopathy of Prematurity (ROP) is a disease where normal vessel growth stops at the edges of the retina following this interrupted process, and abnormal, fragile, and unhealthy new blood vessels develop instead. These new and abnormal vessels can grow into the eye (vitreous fluid), cause bleeding, and most dangerously, create scar tissue (fibrovascular tissue) that wraps around the retina like a net and pulls it away from the layer beneath. This condition is called "retinal detachment" and results in irreversible blindness in the infant if not intervened in the early period.
What are the Risk Factors in ROP Disease?
Retinopathy of Prematurity is not seen in every premature baby. The development and severity of the disease are directly related to the baby's degree of maturity at birth and the medical difficulties experienced during the neonatal intensive care process. The main risk factors are:
- Early Gestational Week: The biggest risk factor. Babies born before the 32nd gestational week are at very high risk. The earlier the baby is born, the less developed the retinal vessels will be, increasing the ROP risk.
- Low Birth Weight: The incidence and severity of the disease increase dramatically in babies born under 1500 grams, and especially under 1000 grams.
- Oxygen Therapy: Since the lungs of premature babies are not fully developed, they often need high concentrations of oxygen support. Sudden fluctuations in blood oxygen levels and uncontrolled high oxygen are among the most important external factors triggering abnormal vessel growth.
- Accompanying Health Problems: Severe infections (sepsis), respiratory distress syndrome (RDS), heart anomalies, brain hemorrhages, and frequent blood transfusions increase the risk of ROP development and the rate of progression.
What are the Stages of Retinopathy of Prematurity?
ROP disease is classified into 5 different stages at international standards according to the abnormal structure of the vascularization and the degree of retinal involvement:
Stage 1: Demarcation Line
The formation of a thin, flat boundary line between the vascularized (normal) region and the non-vascularized (deoxygenated) region of the eye. It often regresses spontaneously without treatment.
Stage 2: Ridge
The boundary line thickens and turns into a ridge protruding from the retina toward the inside of the eye.
Stage 3: Extraretinal Fibrovascular Proliferation
Abnormal new blood vessels and connective tissue prone to bleeding start growing from the ridge into the eye. If the vessels become very dilated and twisted at this stage, it is called "Plus Disease" and requires urgent treatment.
Stage 4: Partial Retinal Detachment
The abnormal connective tissue starts pulling and separating the retina from its place. This is a partial retinal detachment, and surgical intervention is mandatory.
Stage 5: Total Retinal Detachment
The most advanced stage where the retina is completely detached. At this stage, the anatomical structure of the eye is completely disrupted, and surgical success is very low; the disease can result in total blindness.
Symptoms and the Importance of Early Diagnosis
The most dangerous aspect of Retinopathy of Prematurity is that it shows no outward symptoms in the first three stages. The baby's eyes look completely normal from the outside. Only in advanced stages, when the retina is completely detached, a white glow in the pupil (leukocoria) or strabismus may appear, but by this stage, it is usually too late to save the vision. Therefore, the diagnosis must be based on strict and regular screening programs rather than complaints or symptoms.
How is it Diagnosed? Screening Protocol
Specialist Dr. Ayşe Öner and her team work in coordination with neonatal intensive care units within the framework of international pediatric ophthalmology protocols.
- Screening Criteria: All babies born before the 32nd gestational week and/or under 1500 grams must undergo an ROP examination.
- Timing: The first examination is usually performed 4 weeks after birth (or at the 31st postmenstrual week).
- Examination Method: The baby's pupils are dilated with special drops. The specialist examines the back layer of the eye in detail using an "indirect ophthalmoscope" or high-tech wide-angle pediatric retinal imaging systems (RetCam).
What are the Treatment Methods for Retinopathy of Prematurity?
The most appropriate treatment method is determined and applied without delay by Dr. Ayşe Öner according to the stage of the disease.
1. Observation and Follow-up (Stage 1 and 2)
Most early-stage ROP cases heal spontaneously. However, the baby is monitored very closely by the physician at intervals of weeks or even days during this period.
2. Laser Photocoagulation Therapy (Stage 3 and Plus Disease)
The gold standard treatment method. Laser beams are used to destroy the non-vascularized parts of the retina, eliminating oxygen hunger and stopping the growth of abnormal blood vessels.
3. Intraocular Injection Treatments (Anti-VEGF Therapy)
Special drugs that block the protein (VEGF) triggering abnormal vessel growth are injected directly into the eye. It is anatomical-friendly and ensures the rapid shrinking of vessels.
4. Surgical Treatments (Stage 4 and 5)
If the disease has reached the retinal detachment stage, "Pediatric Vitrectomy" surgery is performed to clean intraocular hemorrhages and reattach the retina. Success depends entirely on the high-level experience of the surgeon.
Do not be late for your baby to see the world healthily and brightly. You can contact our patient department immediately for ROP screening and urgent treatment requirements.
Frequently asked questions
In premature babies born before the 32nd week of gestation or under 1500 grams, the development of retinal blood vessels is incomplete. The first ROP examination must be performed exactly 4 weeks after birth (or at the 31st post-menstrual week). The examination is performed with great sensitivity using eye drops and special pediatric lenses by experts with high-level experience in the ROP field, such as Dr. Ayşe Öner, without causing pain to the baby.
It is definitely possible. The disease is monitored according to ROP staging. If the disease reaches the "treatment threshold," abnormal vessel growth is stopped within hours using Laser (cryotherapy/sealing of vessels) or intravitreal Anti-VEGF injections. With timely and correctly applied treatment, life-long blindness is prevented with a success rate near 100%.
Our infant patients and their families are our most sensitive VIP guests. Our clinic is a baby-friendly environment; you will not experience stress in crowded waiting rooms. ROP examinations are conducted in private resting rooms with maternal care and physician precision. If an emergency laser intervention is required, it is performed instantly in our world-class operating rooms accompanied by anesthesiologists, and your baby is safely returned to you on the same day.
