Retinopathy of prematurityAltered development课件.pptVIP

Retinopathy of prematurity Retinopathy of prematurity:Altered development A disorder with a uniquely American heritage Early History Silverman, WA. Retrolental Fibroplasia: A Modern Parable. Monographs in Neonatology. 1980 Dr. Stewart Clifford, Boston pediatrician discovers first case -1941 Dr. Harry Messenger, Boston ophthalmologist coined the term RLF RLF National Cooperative Study Normal oxygen values Retinal vascular development (ontogeny) The choroidal vessels can supply the thin retina via diffusion The retinal nerve cells (photoreceptors) develop from the optic nerve to the periphery Additional blood supply develops as the retinal nerve cell layer becomes thicker Ontogeny of the retinal vascular bed Inner vascular plexus Within the nerve fiber layer Capillaries appear around the 16th week of gestation and reach the ora serrata at about 32 – 36 weeks gestation nasally and temporally just before term Vasculogenesis The goal – supply blood to the maturing retina Ontogeny of the retinal vascular bed Outer vascular plexuses Develops later in gestation and continues to develop postnatally Capillaries arise as cellular buds from the innermost vessels Angiogenesis When ROP develops – How bad is it ? Stage One – A line of demarcation between the vascular and avascular retina Stage Two – The line comes a ridge Stage Three – The ridge is associated with neonvascularization entering the vitreous When ROP develops – How bad is it ? Stage Four – Subtotal detachment of the retina IV – A is extrafoveal detachment IV – B the detachment includes the fovea Stage Five – Total Detachment The old retrolental fibroplasia When ROP develops – How bad is it ? Plus Disease – very tortuous vessels implying high blood flow; bad Rush Disease – Plus disease in zone 1 Stage One Stage Two Stage Three Stage Four Stage Five When ROP develops where is it? ROP – A disease that can regress ROP – A disease that can regress Incidence inversely proport