Retinopathy of Prematurity
This is a bilateral proliferative retinopathy, occurring in premature infants with low birth weight who often have been exposed to high concentration of oxygen. This disease was earlier known as retrolental fibroplasia.
Low birth weight and decreased gestational age are now considered the primary causative factors. Supplemental oxygen administration is now considered only a risk factor. There are two theories that have been postulated to describe the pathogenesis of disease:
- Classical theory which postulates that owing to exposure to high concentration of oxygen, there occurs obliteration of premature retinal vessels. This is followed by neovascularization and fibrous tissue proliferation which ultimately forms a retrolental mass.
- Spindle cell theory proposed recently postulates the induction of retinal and vitreal neovascularisation by spindle cell insult in a premature retina.

Differential diagnosis
Advanced retrolental fibroplasia needs to be differentiated from other causes of leucocoria [opacity of the vitreous presenting as a white pupil].
Screening and management
Treatment of well-established disease is unsatisfactory. Prophylaxis is thus very important. To prevent retinopathy of prematurity (ROP), the premature new borns should not be placed in incubator with an oxygen concentration of more than 30% and efforts should be made to avoid infection and attacks of apnoea. Further, a regular screening is very important.
All premature babies born less than or equal to 32 weeks of gestational age and those weighing 1500g or less should be screened for ROP. The first examination done by indirect ophthalmoscopy should be between 6 and 7 weeks post-natal age or 34 weeks post-conceptual age [which ever is earlier].