Purchase this article with an account.
Michael W Gaynon; ROP - Guided Embryology for Retinal Vessels. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2763.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To discuss addressable patient-care factors, early and late in the course of the initial hospitalization of premature newborns, that may encourage more physiologic retinal vessel formation, hopefully reducing the rate of progression to Type I ROP.
Based on a review of basic science and clinical studies, there will be a discussion of a number of addressable systemic factors during hospitalization after premature birth, both early in the course of hospitalization and later on, when Prethreshold ROP appears.
The following will be discussed as potential interventions during the early and late phases of ROP development:-Oxygen management - What are the optimal settings early and late? Is there a role for supplemental oxygen for prethreshold ROP?-Anemia management - Is there an advantage to maintaining or correcting anemia, early and late?-Light Adaptation State - Given the effect of light adaptation on rod photoreceptor oxygen consumption, what light levels are best early and late?-Nutrition - What do we know about the potential value of supplementing IGF, PUVA and perhaps other nutritionals early and late?
Laser is the gold standard for treatment of Type I ROP, although increasingly anti-VEGF agents are being used either as a monotherapy or in conjunction with laser. Some studies indicate that anti-VEGF agents may be better than laser for the initial treatment of Aggressive Posterior ROP, and may be associated with less myopia than laser, but anti-VEGF agents have their own risks, including late recurrence of ROP, prolonged systemic exposure and loss of fenestrations in the capillary beds of the choriocapillaris, choroid plexus, renal capillaries and capillaries in the pancreas and thyroid. One way to avoid those risks is to optimize postnatal care prior to the development of Type I ROP, so that the decision to treat with anti-VEGF agents or laser never has to be made. Attention to a variety of systemic factors earlier on may have the potential to encourage more physiologic retinal vessel growth, thus avoiding the need to make a choice among potentially hazardous interventions necessary for Type I ROP. There are changing phases during the course of ROP development. Often, the intervention necessary early in the prenatal period may be just the opposite of that needed once Prethreshold ROP appears.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only