Management

In majority of cases, the milder stages of the disease (I and II) resolve by themselves without treatment. However, if the disease progresses and the vision is at risk, treatment is needed. A partial retinal detachment (stage IV) may get better on its own, or may require surgery. A completely detached retina (stage V) almost always requires surgery.

As the disease can advance very quickly, timing is one of the important factors for successful treatment. Recent research indicates that early treatment of severe forms of ROP is effective in decreasing the permanent eye damage, while delayed treatment may reduce the chances of success.

Treatment for ROP depends on the stage and severity of the condition. In general, treatment is undertaken if any of the following indications are reached:

• Zone I, any ROP with "plus" disease;

• Zone I, Stage III without "plus" disease;

• Zone II, Stage III with "plus" disease.

The main goal of treatment is to reduce the risk of retinal detachment. This is achieved by cryotherapy, laser therapy, and retinal surgeries.

Laser therapy usually has better results than cryotherapy and with fewer side effects. Other advantages are that the laser spots are visible during treatment, minimizing the risk of missing. In ROP fails to regress after the initial treatment, re-treatment can be performed in 10-14 days.

Both cryotherapy and laser therapy works by destroying the retina that is deprived of retinal vessels. This helps to shrink the new vessels and prevents the formation of dense scars that may cause traction on the retina. Possible side effects after cryotherapy and laser treatment are intraocular haemorrhage and cataracts. Other treatment complications may include vitreous detachment at 5 weeks, iris atrophy, hypotony, corneal haze, rupture of Bruch's membrane, conjunctival lacerations and nystagmus.

In case of retinal detachment, scleral buckling may be required.

In the more severe cases of ROP, vitrectomy is used to remove scar tissue. During the vitrectomy, the eye lens is usually removed as well.

Education of patients and parents is an important step in the management of ROP. Visual stimulation techniques, proper toys selection, creating proper contrast, alternate learning methods, parental narration and control of light and glare must be planned. Appropriate educational environment should be developed for each child.

ROP patients frequently develop high myopia that requires correction with spectacles. Children should wear adequate protective eyewear fulltime (polycarbonate lenses are preferred because of their high impact resistance) and have non-traumatic activities to reduce the risks for retinal detachment.