Other retinal vascular disease: ROP and occlusions
- Lesion
Premature birth, sickle cell disease, inflammation, radiation and blocked arteries or veins all injure retinal vessels in their own way.
What it is
Several conditions share the sequence of retinal ischemia followed by abnormal new vessels. In retinopathy of prematurity, the incompletely vascularised retina of a preterm infant is first exposed to relatively high oxygen and then becomes ischemic, driving VEGF and neovascularisation. Sickle cells occlude peripheral retinal vessels, causing ‘sea-fan’ new vessels. Retinal vasculitis and radiation injure vessel walls. Central retinal artery occlusion infarcts the inner retina within minutes, while vein occlusion causes hemorrhage and edema.
Step by step
- In the preterm infant, the retinal periphery is not yet vascularised.
- Relatively high oxygen after birth suppresses VEGF and stops normal vessel growth.
- As the retina matures it becomes ischemic and releases VEGF.
- Abnormal vessels grow at the ridge into the vitreous.
- Fibrovascular tissue contracts and can detach the retina.
Retinal vascular disorders beyond diabetes and hypertension
| Disorder | Mechanism | Key sign | Complication |
|---|---|---|---|
| Retinopathy of prematurity | Oxygen shifts in immature retina, VEGF | Ridge between vascular and avascular retina | Tractional detachment |
| Sickle retinopathy | Peripheral vessel occlusion by sickled cells | Sea-fan neovascularisation | Vitreous hemorrhage, detachment |
| Retinal vasculitis | Immune or infectious inflammation of vessels | Vessel sheathing | Occlusion, neovascularisation |
| Radiation retinopathy | Endothelial injury | Microaneurysms, cotton-wool spots | Neovascularisation |
| Central retinal artery occlusion | Embolus or arteritis | Pale retina, cherry-red spot | Permanent visual loss |
| Central retinal vein occlusion | Thrombus at the lamina cribrosa | Diffuse hemorrhages, swollen disc | Macular edema, neovascular glaucoma |
Clinical notes
- Colombia screens preterm infants for retinopathy of prematurity; treatment by laser or anti-VEGF prevents blindness.
- Sudden painless loss of vision in one eye is an emergency; in older adults, giant cell arteritis must be considered.
Test yourself
Think of the answer, then tap the question to see it.
Why does central retinal artery occlusion produce a cherry-red spot?
The infarcted inner retina turns opaque and white, while the thin fovea lets the normal red choroid show through.
What is sea-fan neovascularisation?
Fan-shaped new vessels in the peripheral retina after vessel occlusion in sickle cell disease, especially hemoglobin SC.
What drives the abnormal vessels in retinopathy of prematurity?
VEGF released by ischemic, incompletely vascularised retina after an earlier phase of oxygen-induced vessel arrest.
Elsewhere in DurgiPedia
- Retinopathy of prematurity: who to screen and when
- Sickle cell disease and the eye
- Central retinal artery occlusion: an eye stroke
- Central retinal vein occlusion: workup and follow-up
- Blood supply of the retina and choroid
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Retinopathy of prematurity: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.