Premature baby weighing 1000 gms or less is most likely to suffer from:
Ans. c. ROP (Ref: Yanoff and Ducker Ophthalmology 3rd/606-611; Khurana 4th/264; Parson's 20th/299-300)Premature baby needs to be screened for Retinopathy of prematurity.A 28-week baby suffered from respiratory distress syndrome at birth. On day 14 of life, he developed sepsis, bio other co-morbidity way seen. He should be evaluated for retinopathy ofprematurity at 4 weeks of age.Retinopathy of Prematurrty/Retrolental FibroplasiaBilateral proliferative retinopathy occurring in premature infants (32 weeks or <1.5 kg) exposed to high concentration of O2 during first 10 days of lifeQ.Pathogenesis:Retinal vessels extend up to nasal edge of retina by 8th month of gestation but temporal peripheiy becomes vascularized, by a month after birth.O2 in high concentration leads to vasoconstrictionQ of these immature vesselsThis results in hypoxia followed by neovascularization and fibrous tissue proliferationQRetinal zones of involvement in ROP are divided in 3 zones and centre of retinal map for ROP is optic disc not the maculaQ as in other maps.Clinical features:The condition usually develops within 5-10 weeks of O2 exposureQ.The earliest sign being dilation of retinal veins and appearance of white patches in periphery of retinaQProphylaxis:All babies weighing <1500 gm or having a gestational period <32 weeks should be screened with indirect ophthalmoscopy between 32-36 weeks postconceptionQ.Premature infants should not be placed in incubator with an O2 concentration of more than 30%.Screening of premature infants at 1, 3 and 6 months and every 4 months upto the age of 4 years.Treatment:In initial stages (1 and 2) weekly examination and in advanced stages cryo or laser therapy with sclera buckling or vitrectomyQClassification on the basis of Severity :Stage I:First sign of ROP is the appearance of a thin, flat, white structure at the junction of vascularized retina posteriorly and avscuiar retina anteriorly.Stage II:Demarcation line develops into a pink or white elvation of thickened tissueStage III:Proliferation of vessels over the ridge and into vitreous (extravitreal fibrovascular proliferation)Stage IVa:Partial retinal detachment with macular sparingStage IVb:Partial retinal detachment with macula involvedStage V:Total retinal detachmentClassification on the basis of Anatomical Location:Location of the border between vascularized and avascular retina is an important prognostic sign, as there is a direct correlation between severity of disease and amount of avascular retina.Three zones are divided to describe the location of ROP.Location of the border in zone 1 is the most severe disease and in zone 3 is least.Zone 1:Circle, the center of which is the disc, and the radius of which is twice the distance of the disc of the fovea.Zone 2:Doughnut shaped region that extends from the anterior border of Zone 1 to within one disc-diamter of the orra serrate nasally and to the anatomic equator temporally.Zone 3:Encompasses the residual retina
Cataract
Glaucoma
ROP
Retinal detachment
Congenital and Developmental Disorders