Retinopathy of prematurity

doi:10.1136/bmj.a2648

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Clare M Wilson, specialist registrar, ophthalmology,
Alistair R Fielder, professor emeritus, ophthalmology

¹Department of Optometry and Visual Science, City University, London EC1V 0HB

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