Premature retinopathy
| Classification according to ICD-10 | |
|---|---|
| H35.1 | Premature retinopathy
Retrolental fibroplasia |
| ICD-10 online (WHO version 2019) | |
The retinopathy of prematurity (RPM; Synonyms : retrolental fibroplasia (RLF) or retinopathy of prematurity, retinopathy of prematurity (ROP), Terry's syndrome) is due to the possibility of confusion with retinoblastoma and to the Pseudogliomen counted and is a retinal disease in preterm infants . The cause is the incomplete maturation (vascular supply) of the outer retina at birth in combination with artificial ventilation in the first days of life.
root cause
In the fetus , the outer retina is not yet completely supplied with blood vessels. During pregnancy there is a relative lack of oxygen in the retina ( hypoxia ). This is a stimulus for the retinal vessels to sprout into the outer retina, which is normally completely closed at the time of birth.
If the retina of premature infants, which is still incompletely supplied with blood vessels, does not receive this oxygen deficiency after birth (especially during ventilation), further vascular maturation does not take place; so-called ridges and demarcation lines develop at the boundary between the vascularized and non-vascularized retina. 6 to 8 weeks after the birth, excessive and uncontrolled neovascularization can occur. This happens under growth factors (e.g. VEGF ). In the further course, the vessels can transform into fibrovascular cords, which can lead to retinal detachment ( traction amotio ) and blindness .
Occurrence
The incidence in premature children (<30th week of pregnancy) with a birth weight <1500 g is between 16 and 56%. The disease occurs between the 32nd and 45th week after fertilization. 90% of the children show a spontaneous regression of the changes. The regression takes about 15 weeks. The most important risk factor is the child's level of development at birth; artificial respiration or the addition of oxygen are also important risk factors.
Classification
localization
The classification first describes the presence of the typical stage change with regard to its location in the retina, with the papilla serving as a reference point.
- Zone I: Circle around the papilla with double the distance between the papilla and fovea.
- Zone II: Area peripheral to Zone I up to a circle around the papilla that encloses the ora serrata nasally .
- Zone III: peripheral residual retinal area.
Staging
The pathological changes are divided into different stages:
- Stage 1: thin, sharply defined demarcation line between the peripheral avascular and central vascularized retina.
- Stage 2: increasing extension of the demarcation line in width and height. This so-called bar can be whitish or reddish in color. Retinal vessels can sprout into the groin.
- Stage 3: additional new vascular formations with expansion into the vitreous humor .
- Stage 4a: tractive detachment of the peripheral retina, macula adjacent.
- Stage 4b: tractive detachment of the peripheral retina, macula detached.
- Stage 5: total tractive retinal detachment with the formation of a central retinal funnel. Further sub-groupings can be made depending on the configuration of the funnel.
Additional characteristics
- Plus signs: serpentine vessels as a result of the increased shunt volume, vitreous opacity, increased iris vessel markings, weak pupillary reaction, retinal and vitreous hemorrhages.
- Threshold disease is present when 5 continuous or 8 non-continuous hours are affected by pretinal proliferation (moderate stage 3) and at the same time the vessels at the posterior pole of the eye are pathologically dilated and tortuous (plus sign).
treatment
Treatment depends on the stage and localization of the disease, which are followed up by regular ophthalmological examinations. In the early stages, spontaneous healing can be awaited (under close ophthalmological controls). In later stages, the non-vascularized retina must be obliterated by laser coagulation or ice treatment. A detached retina often needs to be treated with a vitrectomy . The risk of retinal detachment is also increased in later life .
See also
supporting documents
- ↑ http://springerlink.springermedizin.de/content/333u500337758q53/ ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. , P. 75.
