What happens to the retina
By the time of normal birth, the vessels have time to grow to the edge of the retina. If a baby is born prematurely, growth stops and a zone without blood supply remains. This zone secretes substances that stimulate vascular formation, and a shaft with irregular vessels growing from it appears at the border with the normal retina. The process either spontaneously fades, and the retina gradually matures, or progresses. In the worst case scenario, the growing fibrous tissue contracts and tears the retina away from the underlying layers.
- Stage 1 - thin demarcation line at the border of zones
- Stage 2 - the line turns into a towering shaft
- Stage 3 - growth of newly formed vessels into the vitreous body
- Stage 4 - partial retinal detachment
- Stage 5 - complete retinal detachment
- Separately, an aggressive rear form with a fast flow is distinguished
Who's at risk
The main factors are the degree of prematurity and birth weight: the lower the term and weight, the higher the likelihood. Long-term oxygen support with fluctuations in oxygen concentration plays a role, so in modern departments it is carefully dosed and controlled. The risk is increased by severe neonatal periods: sepsis, intraventricular hemorrhages, anemia and blood transfusions, prolonged artificial ventilation, intrauterine growth retardation and multiple pregnancies.
- Gestational age less than 32 weeks
- Birth weight less than 1500 grams
- Long-term oxygen therapy and mechanical ventilation
- Sepsis and severe infections
- Blood transfusions, severe anemia
- Multiple pregnancy, fetal growth restriction
Inspection timing is the most important
Retinopathy develops asymptomatically, and the only protection is a routine examination of the fundus within a strictly defined time frame. The first examination of a premature baby is usually prescribed a few weeks after birth; the exact date is determined by an ophthalmologist based on the gestational age and condition of the child. Further examinations are repeated every one to two weeks, and more often if the picture is alarming, until the vessels grow to the edge of the retina. Missing even one visit is dangerous: the disease can progress to a severe stage in a matter of days, and treatment is effective only in a narrow time window.
- The first examination is prescribed by an ophthalmologist together with a neonatologist
- The examination is carried out with pupil dilation through a special lens.
- Repeat examinations every one to two weeks
- Observation continues until the retinal vessels mature completely.
- A missed visit can cost your child his sight.
- Examinations are not a substitute for assessing the child’s behavior and reactions.
How a child is examined
Before the examination, drops that dilate the pupil and anesthetic drops are instilled. The doctor uses a forehead ophthalmoscope and a special lens, and holds the eyelids with a soft speculum. The procedure takes several minutes and is unpleasant for the child, but not dangerous; Many departments use wide-field retinal cameras, which record the picture of the fundus in the form of an image and allow it to be compared over time. The doctor describes the affected area, stage and presence of signs of vascular activity - the decision on treatment directly depends on this.
- Pupil dilation with drops before examination
- Examination of the fundus through a lens with an eyelid speculum
- Photographic recording with a retinal camera
- Assessment of the zone, stage and activity of the process
- Ultrasound of the eye in opaque media
- Control examinations according to the schedule established by the doctor
Treatment and follow-up
Mild stages often regress on their own, and observation is sufficient. When the threshold stage is reached, treatment is carried out urgently, usually within the next few days: laser coagulation of the avascular zone of the retina is performed or a drug is injected into the eye cavity that suppresses the growth of new vessels. Retinal detachment requires complex surgery and the outcome is no longer guaranteed. Even after successful treatment, the child remains under the supervision of an ophthalmologist for years: such children more often develop myopia, strabismus, amblyopia and glaucoma, which need to be corrected in time.
- Observation for stages 1–2 without signs of progression
- Laser coagulation of the retina at the threshold stage
- Intravitreal administration of the drug according to indications
- Surgery for retinal detachment
- Annual follow-up with an ophthalmologist in the future
- Timely correction of myopia, strabismus, amblyopia
