[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Retinopathy of prematurity [Conditions](https://durgical.com/en/conditions/) · [Pediatrics and neonatology](https://durgical.com/en/conditions/) # Retinopathy of prematurity An eye disease of premature babies in which abnormal blood vessels grow in the retina. Without screening and treatment it can cause blindness. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Retina](https://durgical.com/en/anatomy/retina/) - [Optic disc](https://durgical.com/en/anatomy/optic-disc/) - [Macula](https://durgical.com/en/anatomy/macula/) - [Vitreous](https://durgical.com/en/anatomy/vitreous-body/) - [Choroid](https://durgical.com/en/anatomy/choroid/) - [Lens](https://durgical.com/en/anatomy/lens/) ## Why it happens - [Prematurity and fetal growth restriction](https://durgical.com/en/general-pathology/prematurity-and-fetal-growth-restriction/) - [Neonatal respiratory distress syndrome: surfactant and hyaline membranes](https://durgical.com/en/general-pathology/neonatal-respiratory-distress-syndrome-surfactant-and-hyaline-membranes/) - [Oxidative stress and free-radical injury](https://durgical.com/en/general-pathology/oxidative-stress-and-free-radical-injury/) - [Retina: the ten layers, rods and cones](https://durgical.com/en/histology/retina-the-ten-layers-rods-and-cones/) ## What it is A vasoproliferative disorder of the immature retina in preterm infants. Normal retinal vascular growth stops after birth and is later replaced by abnormal new vessels at the border of the vascularised retina, which can lead to scarring and retinal detachment. ## Who gets it Affects mostly infants born before 30–32 weeks or weighing under 1,500 g. It is one of the leading causes of preventable childhood blindness in Latin America, where larger and more mature babies are affected than in high-income countries because of unmonitored oxygen use; Colombia has national screening guidelines for at-risk preterm infants. ## Causes - Interrupted retinal vascular development after preterm birth - Relative hyperoxia from supplemental oxygen, followed by retinal hypoxia that drives VEGF release ## Risk factors - Low gestational age and low birth weight (the strongest factors) - Uncontrolled or fluctuating supplemental oxygen - Sepsis, poor postnatal weight gain and blood transfusions - Respiratory distress, bronchopulmonary dysplasia and intraventricular haemorrhage ## Pathophysiology Retinal vessels grow from the [optic disc](https://durgical.com/en/anatomy/optic-disc/) towards the periphery and reach it only near term. After preterm birth, relative hyperoxia suppresses VEGF and IGF-1 and vessel growth stops (phase 1). As the avascular peripheral retina matures metabolically it becomes hypoxic and releases VEGF, causing abnormal neovascularisation into the [vitreous](https://durgical.com/en/anatomy/vitreous-body/) (phase 2). Fibrovascular tissue can contract and pull the retina off. ## Classification - Stages 1–5: demarcation line, ridge, extraretinal fibrovascular proliferation, partial retinal detachment, total retinal detachment - Zones I–III: location from the optic disc to the periphery (zone I is most posterior and most dangerous) - Plus disease: dilated and tortuous posterior vessels, marking activity - Aggressive ROP: rapidly progressive posterior disease ## Symptoms and signs - No visible signs in the early stages; detected only by screening - In advanced disease: white pupillary reflex (leukocoria) - Abnormal eye movements (nystagmus) or strabismus - Not fixing on or following faces and objects ## Red flags - Preterm infant at risk who has not had a scheduled eye examination - Plus disease or zone I disease on screening: needs treatment within days - White pupil in a former preterm infant: retinal detachment ## Diagnosis **Clinical** Screening by an ophthalmologist with dilated indirect ophthalmoscopy in all infants who meet national criteria (by gestational age, birth weight or unstable clinical course), starting about 4 weeks after birth or at 31 weeks postmenstrual age, whichever is later, and repeated every 1–3 weeks until the [retina](https://durgical.com/en/anatomy/retina/) is fully vascularised. **Tests** Documentation of zone, stage, extent and presence of plus disease; wide-field retinal photography where available, including telemedicine programmes. **Imaging** Ocular ultrasound when the view of the retina is blocked or detachment is suspected. ## Differential diagnosis - Familial exudative vitreoretinopathy - Retinoblastoma (when leukocoria is present) - Persistent fetal vasculature - Congenital cataract ## Goal of treatment Find treatment-requiring disease in time through screening, stop abnormal vessel growth to prevent retinal detachment, and follow visual development through childhood. ## Treatment **Procedure** Laser photocoagulation of the avascular peripheral retina, the standard treatment for type 1 ROP. **Medical** Intravitreal anti-VEGF injection (such as bevacizumab or ranibizumab), especially for posterior or aggressive disease, with prolonged follow-up for late recurrence. **Surgical** Scleral buckle or vitrectomy for stage 4–5 retinal detachment. **Follow-up** Targeted oxygen saturation ranges with continuous monitoring in neonatal units, timely screening exams, and long-term ophthalmology follow-up for refractive error, strabismus and amblyopia. ## Complications - Retinal detachment and blindness - High myopia - Strabismus and amblyopia - Glaucoma and cataract - Late retinal detachment in adolescence or adulthood ## Prognosis Stages 1 and 2 usually regress without treatment. Timely treatment of threshold disease preserves useful vision in most infants, but stages 4 and 5 have a poor visual outcome. Children who had ROP need lifelong eye checks. ## Prevention - Prevention of preterm birth and good antenatal care - Careful oxygen administration with saturation targets and monitoring - Universal screening of at-risk preterm infants with timely treatment ## Test yourself Think of the answer, then tap the question to see it. ## Which growth factor drives the abnormal vessels in ROP? Vascular endothelial growth factor (VEGF), released by the hypoxic avascular peripheral retina. ## What are the two main risk factors for ROP? Low gestational age/low birth weight and uncontrolled supplemental oxygen. ## What does plus disease mean? Dilated, tortuous posterior retinal vessels indicating active, more severe ROP that usually needs treatment. ## What is the standard treatment for treatment-requiring ROP? Laser photocoagulation of the avascular retina, or intravitreal anti-VEGF injection. ## What nursing priority helps prevent ROP in the neonatal unit? Keeping oxygen saturation within target ranges with continuous monitoring and avoiding fluctuations. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/retinopathy-of-prematurity/) ## Related conditions - [Prematurity and its complications](https://durgical.com/en/conditions/prematurity-and-its-complications/) - [Bronchopulmonary dysplasia](https://durgical.com/en/conditions/bronchopulmonary-dysplasia/) - [Retinal detachment](https://durgical.com/en/conditions/retinal-detachment/) - [Strabismus and amblyopia](https://durgical.com/en/conditions/strabismus-and-amblyopia/) - [Cataract](https://durgical.com/en/conditions/cataract/) - [Retinoblastoma](https://durgical.com/en/conditions/retinoblastoma/) - [Intraventricular haemorrhage of prematurity](https://durgical.com/en/conditions/intraventricular-haemorrhage-of-prematurity/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Retinopathy of Prematurity](https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinopathy-prematurity) (National Eye Institute (NEI), 2026). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/retinopathy-of-prematurity/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/retinopathy-of-prematurity/