(Retrolental fibroplasia)

The retinopathy of prematurity is a bilateral disease with abnormal vascularization of the retina in premature infants, v. a. those with low birth weight. It may therefore come to the restitutio ad integrum to a normal vision, but also to blindness. The diagnosis is made by ophthalmoscopy. The treatment of the heavy RPM with cryotherapy, laser photocoagulation or bevacizumab; other measures are required for the treatment of complications (eg. as retinal detachment).

The inner retinal vessels begin to grow in mid-pregnancy; the complete vascularization of the retina but is made only at the normal due date. A retinopathy of prematurity (RPM), when these vessels continue to grow broadly and without pattern and forming a prominent bar between the central and the vascularized nichtvaskularisierten peripheral retina in the course created. In severe RPM the vessels also penetrate into the vitreous. Sometimes there is a vasodilator with congestion of the blood and a tortuosity vasorum retinae (tortuosity) at the rear Funduspol ( “plus” -disease).

The retinopathy of prematurity is a bilateral disease with abnormal vascularization of the retina in premature infants, v. a. those with low birth weight. It may therefore come to the restitutio ad integrum to a normal vision, but also to blindness. The diagnosis is made by ophthalmoscopy. The treatment of the heavy RPM with cryotherapy, laser photocoagulation or bevacizumab; other measures are required for the treatment of complications (eg. as retinal detachment). The inner retinal vessels begin to grow in mid-pregnancy; the complete vascularization of the retina but is made only at the normal due date. A retinopathy of prematurity (RPM), when these vessels continue to grow broadly and without pattern and forming a prominent bar between the central and the vascularized nichtvaskularisierten peripheral retina in the course created. In severe RPM the vessels also penetrate into the vitreous. Sometimes there is a vasodilator with congestion of the blood and a tortuosity vasorum retinae (tortuosity) at the rear Funduspol ( “plus” -disease). The susceptibility to RPM correlated with the amount of vascularized retina at birth. In newborns with a birth weight of <1 kg RPM occurs at 47 to 80%, and heavy RPM occurs at 21 to 43%. The percentage is even higher if several other complications are present (eg infection, intraventricular hemorrhage. [Intracranial hemorrhage: intraventricular and / or intraparenchymal hemorrhage], bronchopulmonary dysplasia [bronchopulmonary dysplasia (BPD)]). Excessive (especially lengthened) O2 therapy increases the risk. However, an additional administration of O2 is often necessary to provide the child with adequate oxygen. A safe level and duration of O2 therapy is not established. Diagnosis ophthalmoscopy The diagnosis is made by ophthalmoscopic examination, which is carried out by an ophthalmologist. In milder cases, this a prominent bar and a demarcation line extra-retinal fibrovascular proliferation of retinal vessels show in severe cases. An ophthalmoscope for screening is performed on all infants weighing <1500 g or <30 weeks of gestation at birth. Since the onset of the disease usually begins Gestatiosalter at 32 to 34 weeks, the screening begins at 31 weeks. Ophthalmological examinations are all one continued to 3 weeks (depending on the severity of the eye disease) until the infants vascular growth in the periphery have (term infants respectively). Since a serious RPM with adequate supply of infants with> 1500 g birth weight is rare (z. B. familial exudative retinopathy, Norrie’s disease) should also be considered a different diagnosis in these children. The forecast abnormal vessel growth often stops spontaneously, but below postnatally at 4% of the surviving children with a birth weight <1 kg within 2-12 months to a retinal detachment and vision loss continues. Children with a healed RPM have an increased incidence of myopia, strabismus and amblyopia. A few children with a moderate healed RPM keep critical scars (z. B. retinal folds) with the risk of developing later in life retinal detachments. Rarely in such patients also glaucoma or cataracts. Cryotherapy or laser photocoagulation Bevacizumab In the severe form of the RPM decreases the cryotherapy or laser photocoagulation for the ablation of the avascular peripheral retina, the risk of retinal folds and -ablösung. The retinal vascularisation has to be examined at one- to two-week intervals until the vessels are sufficiently mature. If retinal detachments occur in infancy, a scleral fixation or a vitrectomy with lens extraction can be considered, but these measures are more desperate attempts at treatment without much success. In patients with remaining scars should be at least once a year are carried out a check-up. Treatment of amblyopia and refractive errors within the first year optimizes vision. Children with a retinal detachment should be monitored because of the risk of secondary glaucoma and a reduced eye growth and appropriate treatment programs for the visually impaired are fed. Bevacizumab is a new anti-vascular endothelial growth factor monoclonal antibody that stops the progression of RPM. Compared to laser therapy bevacizumab has a lower recurrence rate and less structural abnormalities. If the disease returned, this happened months later; Long-term follow-up studies of ophthalmology are required. Concerns about systemic absorption and possible infection related to the need for optimal dosage and timing of follow-up are the reasons that this drug is still treating the second choice, which can be used to treat a serious illness or in conjunction with a laser therapy. Prevention but it comes too premature birth, just as much O2 should be used as is necessary to avoid O2 fluctuations because both hyperoxia and hypoxia increase the risk of RPM. Vitamin E and light restriction are not effective. Important points retinopathy of prematurity (RPM) develops usually in infants with a birth weight of <1500 g and <30 weeks of gestation at birth, especially those who had serious medical complications or excessive and / or prolonged O2 Therapy have received. The risk increases with increasing immaturity. Most cases heard spontaneously, but a small number developed a retinal detachment and loss of vision 2 to 12 months after childbirth. Infants at risk are a ophthalmoscopic examination (performed by an ophthalmologist) from 31 weeks gestation screened. The use of supplemental O2 for a preterm delivery is minimized. Heavy RPM is treated with laser photocoagulation or bevacizumab.

Health Life Media Team

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