Treatment of retinopathy in premature infants: What you need to know

This is an automatically translated article.

The article is expertly consulted by Master, Doctor Phan Thi Cam Van - Department of Pediatrics - Neonatology - Vinmec International General Hospital Da Nang. He has 07 years of experience as a Resident Doctor and a Pediatrician - Neonatal Doctor at Hue Central Hospital and Hue University Hospital of Medicine and Pharmacy. In particular, he has strengths in the care and treatment of newborns, neonatal resuscitation, respiratory and digestive diseases, feeding, and common newborn problems.
Many premature babies are saved, but are at risk of permanent blindness in both eyes due to untreated retinopathy of premature babies. Treatment of retinopathy in infants requires early and aggressive action.

1. Screening before treatment

Retinopathy of prematurity in the early stages cannot be detected with the naked eye. On the surface, the baby's eyes appear completely normal. By the time it manifests itself, the disease is too late and there is no chance for a cure. Therefore, it is necessary for the baby to be screened with an eye specialist within about 4 weeks after birth in order to diagnose the disease early as well as improve the effectiveness of treatment.
In Vietnam, screening for retinopathy of preterm infants is usually performed in all children with the following characteristics:
Premature birth less than 34 weeks Birth weight less than 2 kg Having risk factors such as: Respiratory failure breathing, prolonged oxygen, anemia, infection... To detect the disease, the child will first be instilled with a pupil dilator with the aim of helping the doctor see the entire retina. Then, the ophthalmologist will examine and evaluate the child's eyes with a set of specialized equipment, including: a special machine and an indirect ophthalmoscope (similar to a converging lens).

2. Prepare for an eye exam

In order to help the examination process go smoothly, before taking your child to a medical facility for an eye exam, parents need to keep a few notes in mind:
Register before the examination date: Parents can register through online, by phone or directly to the clinic without taking the child with you. Then just let your baby go to the eye exam at the scheduled time to avoid waiting. Fasting for at least 1 hour before the examination: Young children often cry during the examination, leading to aspiration of milk which is very dangerous and can cause death. Prior fasting will help prevent this from happening. Bring the necessary documents, for example: Discharge letter, referral for eye examination, antenatal and ultrasound examination results of mother, follow-up appointment slip... The doctor needs to know all the relevant details. to the previous pregnancy as well as the neonatal period.

3. Treatment of retinopathy in infants

3.1. Treatment principles
General principles in the treatment of neonatal retinopathy:
Prevent retinal detachment due to advanced disease Reduce the risk of further formation of avascular retina 3.2. Treatment methods
Treatment methods for retinopathy in infants currently being applied include:
Laser surgery (also known as photocoagulation) The doctor will use a laser beam to project Through the dilated pupil, it acts directly and precisely on the retina to burn, creating small burn scars. This technique works to stop the growth of abnormal blood vessels and prevent retinal detachment.
Cryotherapy (also known as cryotherapy) This technique also has the same purpose of scaring the inside of the retina, preventing the spread of abnormal blood vessels and retinal detachment. However, the surgeon will use a cold metal tip to indirectly affect the retina through the sclera. Before the procedure, it is necessary to dissect the conjunctiva to expose the sclera area to achieve the desired effect in the retina.
Sclerotherapy The doctor will place a silicone band around the white of the eye and adhere it firmly. This method helps push the eye inward, preventing vitreous fluid from sloughing off the scar tissue, so that the retina is kept on the back wall of the eye longer. Until the baby's eyes develop stably, it is necessary to remove the silicone buckle, otherwise the child may become nearsighted.
Removal of vitreous (vitrectomy) In this procedure, the vitreous in the child's eye is removed and replaced with normal saline solution. The doctor can then peel or cut away the scars on the retina, allowing them to relax and lie close to the back wall of the eye. This surgical method is usually indicated for children with stage 5 retinopathy (total retinal detachment).

4. Follow-up and follow-up

The effectiveness of treatment measures depends on the severity of the disease. If the child has only mild or moderate disease, together with early detection, there will be positive results. Sometimes many children with retinopathy recover on their own, without requiring any treatment. In contrast, when the disease is severe, no matter what form of treatment, the risk of vision loss is still very high. Even in the case of delayed diagnosis, the disease has progressed to the stage of retinal detachment, the child will be permanently blind.
However, even if the treatment is effective, some late complications can still occur such as:
Myopia Strabismus / crossed eyes Amblyopia Glaucoma Lateral vision function will be based on many different factors during the child's maturation. Therefore, long-term follow-up at pediatric ophthalmology hospital plays a necessary role in order to detect and intervene in time. Particular attention should be paid to cases where only one eye is affected or the degree of disease in both eyes is uneven.
For the safety of children's eyes, parents cannot skip taking their children for regular eye exams. It is very important to follow the regular and long-term follow-up appointment as prescribed by the doctor. Retinopathy in premature babies, if not examined, diagnosed and treated promptly, will lead to very dangerous blindness complications, which are difficult to recover. Therefore, infants born prematurely, with low birth weight and at high risk should be screened for disease immediately after birth.
As a key area of ​​Vinmec Health system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of top doctors and nurses in Pediatrics : consists of leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All doctors are well-trained, professional, conscientious, knowledgeable about young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.

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