Retinopathy of prematurity

What it is

Blood vessels of a premature baby's retina grow abnormally and can pull the retina off; a leading cause of childhood blindness in middle-income countries.

Symptoms & signs

• No symptoms early — found only by screening
• later white pupil, squint or wandering eyes
• poor vision or blindness
• high short-sightedness in childhood

Where it strikes

• Retina

Medical treatment

• Screening eye examinations for babies born before 31–32 weeks or under 1.5 kg
• Laser to the outer retina (earlier freezing) — roughly halves unfavourable outcomes (CRYO-ROP, ETROP) trials support
• Anti-VEGF injection (bevacizumab, ranibizumab, aflibercept) — RAINBOW: ranibizumab at least as good as laser with less short-sightedness; recurrence needs longer follow-up and effects on the growing body are unknown; ranibizumab EU-approved 2019 mixed evidence
• vitrectomy for detachment
• glasses and patching for short sight and squint

Natural & lifestyle

• Careful oxygen targeting — saturations of 91–95% cost more eye disease than 85–89% but fewer deaths (BOOST, SUPPORT) trials support
• mother's milk

Emerging & experimental

• Omega-3 and arachidonic acid supplements — Mega Donna Mega: less severe disease early / small studies
• oral propranolol — early trials

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

• Vitamin E supplements — less severe disease in trials, but more sepsis and bowel injury at high doses; not routine mixed evidence
• Dimming the nursery lights — LIGHT-ROP trial: no effect not confirmed in trials

ICD codes

• ICD-10 H35.1
• ICD-11 9B71.3 Retinopathy of prematurity