1.Dr. Lakshmi.K.S Moderator: Dr. Devika.P 1

2. 25/9/2013 On Examination Right Left (Torchlight) Eye Lids N N External structures N N Eye malalignment - - Nystagmus - - Sclera yellowish yellowish Cornea clear clear Iris N N Lens clear clear 2 3. Direct ophthalmoscope R L Red reflex + + Indirect ophthalmoscope Dilated fundus examination 3 4. Dilated fundus on 25/9/2013 4 5. 5 6. Dilated fundus on 3/10/13 6 7. 7 8. Dilated fundus on 6/10/13(post laser left eye) 8 9. 9 10. Rx: Tobramycin Dexamethasone Eye Drops QID * 1 week Review after 3 days 10 11. Dilated Fundus on 10/10/13 11 Laser Marks seen, plus regressedAll Zones Vascularized 12. Discussion: Diagnosis Early diagnosis and secondary prevention of visual loss must International Classification of ROP (ICROP) is used: For documentation of the deterioration or regression of ROP For therapeutic interventions *The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005;123:991-9 12 13. CLASSIFICATION- ICROP ZONE/ LOCATION SEVERITY EXTENT PLUS DISEASE PREPLUS DISEASE 13 14. Zone 1. Location Zone I Circle with optic nerve at center and a radius of twice the distance from optic nerve to macula Zone II A concentric circle From edge of Zone I to the nasal ora serrata Zone III Lateral most crescent shaped area from Zone II to ora-serrata temporally 14 15. ZONES 15 16. SEVERITY 16 17. Stage 1 Presence of thin white demarcation line separating the vascular from avascular retina 17 18. Stage 2 The line becomes prominent because of lifting of retina to form a ridge having height and width 18 19. Stage 3 Presence of extra retinal fibro- vascular proliferation with abnormal vessels and fibrous tissue arising from the ridge and extending into vitreous 19 20. Stage 4 Partial retinal detachment; not involving macula (4A) or involving macula (4B) 20 21. 21 STAGE IV a STAGE IV b 22. Stage 5 Complete retinal detachment 22 Open open, open narrow, narrow open, narrow narrow 23. Extent Extent of involvement of the retina expressed as clock hours (30 degree sectors) 8+ cumulative clock hour sectors 5+ continuous clock hour sectors 24 24. Plus disease Presence of dilatation and tortuosity of posterior retinal vessels of at least 2 quadrants. Associated with vitreous haze, pupillary rigidity Arises gradually or very rapidly. Due to AV shunting mainly in ridge tissue Severity indicator 25 25. Often associated with -Iris vessel engorgement -Miosis -Resistance to dilating medications -Vitreous haze -Tunica vasculosa lentis 26 26. Pre-plus disease Vascular abnormalities of the posterior pole that are insufficient for the diagnosis of plus disease but that demonstrate more arterial tortuosity and more venous dilatation than normal serves as a warning 27 27. CLINICALLY SIGNIFICANT TERMS Threshold ROP: CRYO ROP study Zone I stage III with Plus Zone II Stage III with Plus ( 5 contigous or total 8 clock hours) *Cryotherapy for Retinopathy of Prematurity Cooperative G. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity: preliminary results. Arch 28 28. Prethreshold ROP: ETROP study* High risk Prethreshold Zone I , any stage with plus Zone 1, Stage 3 without plus Zone II Stage 2 and 3 with plus Perepheral retinal ablation indicated *Early Treatment For Retinopathy Of Prematurity Cooperative G. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 2003;121:1684-94 29 29. AP-ROP: aggressive posterior ROP -Earlier known as RUSH Disease -posterior location, -rapidly evolving preplus and plus disease neovascularization that may be subtle or even intraretinal in nature. -Progress to stage IV & V in 2-3 weeks without passing through characteristic stages II and III - requires laser treatment more than once 30 30. Which babies should be screened? Babies with birth weight