In the Hospital - a quick look

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For some parents of preemie babies, the neonatal intensive care unit (NICU for short) becomes a home away from home while they wait for their preemie baby to get strong enough to leave.


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The NICU is where your preemie baby will get lots of help.

It can be noisy, confronting, and stressful. Learning a little about the equipment, what health professionals are doing, and some of the medical jargon can help parents of preemie babies feel more confident and less overwhelmed.
Preemie help is here to make sense of it all.

 


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Retinopathy of Prematurity Surgeries & Procedures

The following article provides some basic information about the surgeries and procedures used to treat preterm infants with retinopathy of prematurity (ROP)

Overview of Surgery and ROP

Most cases of ROP are mild and recover without preterm infants needing surgery or other treatment; in fact approximately 90% of all preterm infants with ROP have mild cases and do not require treatment.

Preterm infants without ROP or mild cases of ROP can still be at risk for other visual problems, see Visual impairments and preterm infants.

Preterm infants with severe ROP can develop impaired vision and even blindness and therefore may need treatment to prevent or limit the affects. If your preterm infant needs treatment, they may receive surgery to stop the growth of the abnormal blood vessels. The type of surgery used to treat ROP may differ between preterm infants depending on the degree of ROP but your doctor will make this decision based on what is best for your prem. Learn a little more about it so you understand more about your preemie’s situation and it will make the whole experience a bit easier to you to cope with.

Stage 1 or 2 ROP usually doesn’t require surgery and instead your preemie’s doctor will probably schedule regular eye examinations to make sure your preemie’s condition does not get any worse. You should always make sure you take your preemie to these appointments. For higher stages of ROP your preemie may need to have surgery. This is usually done under general anesthesia, which means your preemie will be “asleep” through the procedure.

Treatment

ROP surgery is done to stop the abnormal blood vessels at the back of the eye from growing and damaging vision. The surgery will involve treating the sides of the retina (called the peripheral retina) so that the middle and most important part of the retina (the central retina) isn’t affected. Surgery for ROP actually scars areas on the side of the retina to stop the abnormal growth, this means that some of your preterm infant’s peripheral vision may be lost but importantly central vision is saved. This is important because your preemie will be able to perform vital visual functions, such as seeing straight ahead, seeing colour, reading and so on.

The methods used to treat ROP include:

  • Laser surgery
  • Cryotherapy
  • Scleral Buckling
  • Vitrectomy

Types of Surgery for ROP

Your preemie’s pediatric ophthalmologist will describe the procedure required for your baby and answer your questions. It can be a good idea to do a little bit of research first so if there’s anything you don’t understand or that you’re concerned about you can ask before the procedure.

Surgery for ROP is usually performed with the preterm infant under either general anesthesia (medication that induces a deep sleep-like state) or deep sedation (medication that makes the preemie unaware of the procedure but not as deeply sedated as with general anesthesia).

Surgeries for Mild ROP

Laser surgery

This is the most commonly used type of ROP surgery, which uses small laser beams to scar the peripheral retina. You might also hear medical professional refer to this as laser therapy or photocoagulation. Laser surgery takes approximately 30-45 minutes for each eye and is usually done at preterm infant’s bedside with sedation and pain medication.

Cryotherapy

In this treatment a piece of equipment called a cryoprobe is placed on the outside of the eye. The tip of the cryoprobe gets extremely cold so that it freezes the abnormal blood vessels growing inside the eye. This will stop the growth of blood vessels and make them shrink away. Cryotherapy, also called cryosurgery used to be the most common method of surgery for ROP but laser surgery is now the preferred method in most instances. Cryotherapy is also usually performed at the preterm infant’s bedside with sedation and pain medication.

(Clark & Mandal, 2008; Faia & Trese, 2011; Kim & Lee, 2010; Uparkar et al., 2011)

Surgeries for Severe ROP

The following methods are used for cases where preterm infants have more advanced stages of ROP, where the abnormal blood vessels and scar tissue damage the retina by pulling it away from the inside surface of the eyeball. This is called retinal detachment and can cause serious vision loss:

Scleral buckling

One of the ways to reduce tension on the retina is to push the wall of the eyeball inward. This involves placing a flexible band, usually made of silicone, around the eyeball. The band is placed around the sclera, the white of the eye, causing it to push in, or buckle, so that the torn retina pushes closer to inside surface of the eye. Scleral buckling takes 1-2 hours.

Outcomes after Scleral Buckling

Around 70% of preterm infants who undergo scleral buckling have a successful outcome in terms of the retina reattaching. This does not always result in improved vision with approximately 50% of preterm infants having restored vision after the surgery. It will likely take a few months before it is known whether the retina has reattached or not. It is extremely rare for complications to result following this type of surgery.

Vitrectomy

In situations where preterm infants have a large amount of scar tissue and blood vessels, the surgeon might have to remove some of the clear gel-like fluid that fills the center of the eye. This gel-like fluid is called the vitreous. Removing the vitreous means the surgeon can remove the scar tissue and eases pulling on the retina. This should help reduce the risk of retinal detachment and visual loss. Vitrectomy can take several hours.

Outcomes after Vitrectomy

Of the preterm infants who undergo Vitrectomy surgery for ROP the retina reattaches in 30% to 40% of preemies and only 10% to 15% have useful vision restored. Without this surgery however there is no chance for visual recovery. Complications following Vitrectomy are rare, there is a small chance of bleeding or infection. Research has shown that surgery done when preterm infants are younger has a greater chance of restoring vision. This is because the retina has probably been detached for a shorter amount of time.

(Aoyama et al., 2010; Bhende, Gopal, Sharma, Verma, & Biswas, 2009; Hubbard, 2008; Repka, Tung, Good, Capone, & Shapiro, 2011; Shah, Narendran, Kalpana, & Tawansy, 2009)

Caring for Your Preterm Infant after Surgery

The primary aim of surgery for retinopathy of prematurity is to stop the progression of the disease and prevent blindness. Although ROP surgery has a good success rate, not all preterm infants respond to treatment. Up to 25% of preterm infants who have ROP surgery might still lose some or all vision.

In all types of ROP surgery, a degree of your preemie’s peripheral (side) vision will be lost. Even if the ROP has stopped progressing, vision still can be affected, see Visual impairments and preterm infants for more information.

  • Follow-up care for ROP surgery includes giving your child eye drops (to prevent infection) for at least a week.
  • Eye exams are usually scheduled based on instructions from the ophthalmologist, which is usually every 1-2 weeks.
  • For scleral buckling, the ophthalmologist will examine the buckle every 6 months.
  • Any preterm infant who has undergone surgery for ROP should have regular, yearly eye exams well into adulthood.
  • If you have any questions or concerns you should always speak with your doctor or ophthalmologist.
(Hubbard, 2008; Repka, et al., 2011; Zaichkin, 2009)

Additional Resources

There are several groups that offer advice and support for parents

American Associations

These websites are not operated by Preemie Help. Preemie Help is not associated with these websites in any way, nor does it endorse or take responsibility for any of the content. These links are provided for the convenience of our users.

 


Technical Reference List

Aoyama, K., Kondou, Y., Suzuki, Y., Sakai, H., Oshima, M., & Inada, E. (2010). Anesthesia protocols for early vitrectomy in former preterm infants diagnosed with aggressive posterior retinopathy of prematurity. Journal of anesthesia, 24(4), 633-638.
Bhende, P., Gopal, L., Sharma, T., Verma, A., & Biswas, R. K. (2009). Functional and anatomical outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 retinopathy of prematurity. Indian journal of ophthalmology, 57(4), 267-271.
Clark, D., & Mandal, K. (2008). Treatment of retinopathy of prematurity. [; Review]. Early Human Development, 84(2), 95-99.
Faia, L. J., & Trese, M. T. (2011). Retinopathy of prematurity care: screening to vitrectomy. [Review]. International ophthalmology clinics, 51(1), 1-16.
Hubbard, G. B., 3rd. (2008). Surgical management of retinopathy of prematurity. [Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review]. Current opinion in ophthalmology, 19(5), 384-390.
Repka, M. X., Tung, B., Good, W. V., Capone, A., Jr., & Shapiro, M. J. (2011). Outcome of eyes developing retinal detachment during the early treatment for retinopathy of prematurity study. Archives of ophthalmology, 129(9), 1175-1179.
Shah, P. K., Narendran, V., Kalpana, N., & Tawansy, K. A. (2009). Anatomical and visual outcome of stages 4 and 5 retinopathy of prematurity. Eye (London, England), 23(1), 176-180.
Uparkar, M., Sen, P., Rawal, A., Agarwal, S., Khan, B., & Gopal, L. (2011). Laser photocoagulation (810 nm diode) for threshold retinopathy of prematurity: a prospective randomized pilot study of treatment to ridge and avascular retina versus avascular retina alone. International ophthalmology, 31(1), 3-8.
Zaichkin, J. (2009). Newborn Intensive Care: what every parent needs to know (3rd ed.). MI: Sheridan Books.

 

 



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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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