Endgames Picture quiz

Retinopathy of prematurity

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2648 (Published 04 December 2008) Cite this as: BMJ 2008;337:a2648
  1. Clare M Wilson, specialist registrar, ophthalmology,
  2. Alistair R Fielder, professor emeritus, ophthalmology
  1. 1Department of Optometry and Visual Science, City University, London EC1V 0HB
  1. Correspondence to: C M Wilson clarewil25{at}yahoo.com

    The figure is a wide field image taken with a RetCam (Clarity Inc, Pleasanton, CA, USA) at 39+4 weeks’ postmenstrual age from a baby born at 27+5 weeks’ gestation (birth weight 940 g). He needed prolonged ventilation for respiratory distress syndrome, and he underwent surgery for necrotising enterocolitis. Now aged 5, he is seen regularly at the eye clinic for myopia and intermittent exotropia, which his mother reports is most obvious at the end of the day.

    Questions

    • 1 Which preterm babies are screened for retinopathy of prematurity in the United Kingdom?

    • 2 What stage of retinopathy of prematurity does this baby have and how should he be managed?

    • 3 What other ophthalmic sequelae are common in children born prematurely?

    Answers

    Short answers

    • 1 In the UK all babies weighing less than 1501 g or born before 32 weeks’ gestation should be screened for retinopathy of prematurity.

    • 2 This baby has stage 3 retinopathy of prematurity with “plus disease” (fig 2) and should have 360° peripheral laser treatment anterior to the lesion within 48-72 hours. The right eye is similarly affected and needs to be treated—retinopathy of prematurity is typically bilateral and symmetrical.

    Fig 2 Retinopathy of prematurity pathology visible on image

    • 3 Refractive errors, in particular myopia, strabismus with an unusually high rate of exotropia, amblyopia, and cerebral visual impairment.

    Long answers

    1 Which preterm babies should be screened?

    Retinopathy of prematurity is a potentially preventable cause of blindness in children. The proportion of childhood blindness …

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