Update in the Treatment of Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP) is an alteration in the development of the immature retina vascularization that frequently occurs in premature infants and is one of the leading causes of childhood blindness worldwide. In threshold stage retinopathy, laser photocoagulation is the standard treatment, particularly in those located in zone II. However, this therapy destroys parts of the retina and can lead to significant eye complications later in life. For this reason, in the last few years, antivascular endothelial growth factor agents are being used as monotherapy or as coadjuvant with laser, especially in retinopathy located in zone I. More recently, the administration of oral propranolol has been used as prevention and/or treatment of prethreshold retinopathy with encouraging results. This review provides an overview of the current evidence on newer treatment strategies for ROP. Key Points

Etiology and health considerations of visual disability during early childhood: a review

“…It is the leading cause of childhood blindness in developing countries such as India and China, and in Latin American and Eastern European countries 23 . The main risk factors of this condition are premature birth, low weight at birth, supplementary use of oxygen, and neonatal sepsis related to immaturity during the histological, neuronal, and vascular development of the retina.…”

“…The clinical practice guidelines recommend conducting visual tests through indirect ophthalmoscopy in all newborn babies under 32 gestational weeks or in those who are born weighing less than 1500 grams 23 . Primary prevention requires identifying the risk factors for ROP 28 , and secondary prevention is based on identifying the disease early, and treating patients who need it in a timely manner it.…”

Etiología y consideraciones en salud de la discapacidad visual en la primera infancia: revisión del tema

“…Es la principal causa de ceguera infantil en los países en vías de desarrollo, como India y China, y en países de Latinoamérica y de Europa del Este 23 . Los principales factores de riesgo de esta patología son el parto pretérmino, el bajo peso al nacer, el uso suplementario de oxígeno y la sepsis neonatal relacionados con inmadurez en el desarrollo histológico, neuronal y vascular de la retina.…”

“…Las guías recomiendan hacer tamizaje con oftalmoscopia indirecta a todos los recién nacidos menores de 32 semanas de gestación o con un peso al nacer menor de 1500 gramos 23 . La prevención primaria requiere identificar los factores de riesgo para ROP 28 , y la prevención secundaria se basa en identificar la enfermedad de forma temprana y hacer tratamiento oportuno de los pacientes que lo requieran.…”

“…El estándar de referencia en el manejo de esta patología para evitar la pérdida de visión central en niños con ROP grave es la terapia ablativa láser (fotocoagulación laser) 29 . Otras opciones de manejo son los anticuerpos frente al factor de crecimiento vascular endotelial, como el bevacizumab 30 , y en casos más avanzados el tratamiento quirúrgico paliativo 23 .…”