THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE: Expanding the Boundaries of Diagnosis and Treatment : RETINA

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THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE

Expanding the Boundaries of Diagnosis and Treatment

Yonekawa, Yoshihiro MD*,†; Thomas, Benjamin J. MD‡; Thanos, Aristomenis MD§,¶; Todorich, Bozho MD, PhD§,¶; Drenser, Kimberly A. MD, PhD§,¶; Trese, Michael T. MD§,¶; Capone, Antonio Jr MD§,¶

Author Information

*Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts;

†Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts;

‡Florida Retina Institute, Jacksonville, Florida;

§Associated Retinal Consultants, Royal Oak, Michigan; and

Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan.

Reprint requests: Antonio Capone, Jr., MD, Associated Retinal Consultants William Beaumont Hospital, 3555 W. Thirteen Mile Road, Suite LL-20, Royal Oak, Royal Oak, Michigan MI 48073; e-mail: [email protected]

Consultant for Novartis (A. Capone), consultant for Synergetics (A. Capone, K. A. Drenser, M. T. Trese), founder and equity owner of FocusROP and Retinal Solutions (A. Capone, K. A. Drenser, M. T. Trese). The remaining authors have no financial/conflicting interests to disclose.

Retina 37(12):p 2208-2225, December 2017. | DOI: 10.1097/IAE.0000000000001719

Purpose: 

To discuss the latest advances and controversies in the diagnosis and care of infants with retinopathy of prematurity (ROP).

Methods: 

Literature review.

Results: 

Retinopathy of prematurity remains a major global issue. Industrialized nations now treat profoundly premature infants with posterior and aggressive disease, and middle-income nations are experiencing ROP epidemics. Remote digital imaging may address the decreasing ratio of ROP providers to premature infants, in addition to improving patient care. Widefield angiography, optical coherence tomography, and the Wnt signaling pathway have provided new insights into ROP pathogenesis. Anti–vascular endothelial growth factor treatment is increasing in popularity, but the dearth of information to guide dosing, unpredictable reactivation, persistent vascular abnormalities, the “crunch” phenomenon, and the presently unknown effects of systemic vascular endothelial growth factor suppression remain issues to continue investigating. Neurodevelopmental delay has been raised as a potential consequence, but the evidence currently is weak. Vitrectomy is the treatment of choice for Stages 4 and 5. Illumination techniques, ab interno incisions, plasmin-assisted vitrectomy, staged surgery in the interest of corneal clearing for advanced Stage 5, and immediate sequential bilateral vitreoretinal surgery, are useful techniques.

Conclusion: 

We are making progress in ROP management. Our goal as clinicians is to continue expanding the boundaries of our abilities to keep this blinding disease in check globally.

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