Retinopathy of Prematurity

00:01 Our first topic here is a newborn and I don't mean any newborn, not a term, we have a newborn who's a preemie, so maybe 27 weeks.

00:10 36 weeks is approximately normal, correct? 27 weeks I've given you.

00:14 Now, the only choice that you have at this point is to then place a beautiful newborn, right, in the NICU, in other words in neonatal ICU.

00:25 The only choice that you have now in this 27-week-old preemie will then be to provide oxygen.

00:34 Do you think this newborn that is a preemie at 27 weeks is able to handle all these oxygen that you and I as an adult should be having? I don't know.

00:47 Beause there's every possibility that the oxygen may then become a free radical or reactive oxygen species or reactive oxygen intermediate, whatever you wanna call it.

00:56 And that free radical, the oxygen therapy, may then cause damage to retina prematurely in which this newborn then goes into blindness.

01:08 Unfortunate.

01:09 This is then called retinopathy of prematurity, ROP.

01:15 Hopefully, the ROP newborn doesn't go into RIP.

01:20 A lot of times that happens.

01:22 You have no choice.

01:24 You have no choice.

01:25 You have to give oxygen and then in pathology we've talked about how the first 27 weeks there's every possibility that the newborn may not have surfactant.

01:34 So in addition there might be neonatal respiratory distress syndrome, correct? In addition, there might be necrotizing enterocolitis, there might bronchodysplasia.

01:42 So put the entire patient holistically.

01:46 Make sure that you know what's going on when there's free radical damage in the newborn.

01:50 A bunch of complications that you must know.

01:52 Now with retinopathy of prematurity, when you're destroying this retina, the retina then becomes extremely, extremely desperate for blood vessels.

02:03 So you're gonna have VEGF-mediated which stands for vascular endothelial growth factor.

02:10 And you're gonna have these little blood vessels that are now being formed.

02:13 It's called neovascularization.

02:16 The neovascularization is occurring in this premature newborn.

02:22 It could be extremely dangerous so therefore, part of the therapy could be the anti-VEGF therapy as well.

02:29 Keep that in mind, that's important.

02:31 Vascular proliferation in retinopathy of prematurity.

02:34 You'll have grey avascular retinal border.

02:38 It's a newborn who is premature so therefore, the retinal border is not receiving enough blood.

02:44 This part could actually be normal because it's a preemie.

02:49 The neovascularization, as you see here in the schematic, is going to be dilated, tortuous blood vessels.

02:58 What does that represent? Neovascularization.

03:01 What happened here? A premature child, maybe 27 weeks, receiving oxygen and in the process may then cause free radical damage.

03:11 You'll have a dragged optic disc pulled by the preretinal membrane as I talked about and recurrent retinal bleeding in neovascularization.

03:23 As all what you're seeing here depicted in the retina.

03:25 This is of a newborn.

03:28 Can you see all those little blood vessels? That's a lot of neovascularization.

03:32 All that neovascularization might then be pulling on the retinal layer and in the process you're worried about retinal detachment.

03:41 And also this neovascularization or the new blood vessels, they're extremely, extremely weak and vulnerable to rupture.

03:50 And if that happens you'll have retinal bleeding.

03:52 You see the dark areas in the'it pulls the blood here a little bit'in your fundoscopic examination.

03:59 All parts of retinopathy of prematurity.