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Fierson WM, et al.,
AAP, AAPOS, AAO, Screening Examination of Premature Infants for
Retinopathy of Prematurity. Pediatrics 2001, 108(3):809-11.
The Main Points:
1)
Infants less than 1500g or
28 weeks, or those at high risk 1500-2000g should get at least 2 eye
exams.
2)
The exam should be performed
by someone with experience.
3)
The first exam should be at
31-33 weeks post conceptional age, or sooner, if area or risk factors
determine, but not before 4 weeks of age.
4)
Guidelines for follow up
exams are given:
a.
Immature vessels in zone I ö
follow up in 1 to 2 weeks.
b.
ANY ROP disease in zone I ö
follow up in 1 week (or less).
c.
Stage 3 disease in zone II,
or stage 2 with plus disease in zone II ö follow up in 1 week.
d.
Less severe ROP in zone II ö
follow up in 2 weeks.
e.
No ROP in zone II ö follow
up in 2-3 weeks
f.
Zone III, no ROP - requires
at least one additional confirmatory exam.
5)
Zone I or border zone I-II
disease may appear atypical and require more
Aggressive following and laser sooner.
6)
Parents should be informed
of the eye disease state and progress.
7)
Follow up at discharge is
critical. Written and verbal information should be given to the
parents. If the patient cannot be guaranteed timely outpatient follow
up --- THE PATIENT SHOULD NOT BE DISCHARGED.
|
Gestational Age |
Weeks until first exam |
Corrected Gestational age |
|
23 weeks |
8 |
for first exam |
|
24 weeks |
7 |
31 weeks |
|
25 weeks |
6 |
31 weeks |
|
26 weeks |
5 |
31 weeks |
|
27 weeks |
4 |
31 weeks |
|
28 weeks* |
4 |
32 weeks |
|
29 weeks |
4 |
33 weeks |
|
30 weeks |
4 |
34 weeks |
|
31 weeks |
4 |
35 weeks |
|
32 weeks** |
4 |
36 weeks |
*
Infants over 1500g and low risk may not require eye exams
** Infants over 32 weeks rarely need to be seen unless extreme risks.
High
risk factors: Under 750g, under 26 weeks gestational age, oxygen use,
sepsis, Necrotizing enterocolitis (NEC), Intraventricular Hemorrhage
(IVH), multiple births, ischemia, acidosis.
Other
risk factors: under 1000g, under 30 weeks, anemia, light skin
pigmentation.
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