Insights in ROP

Background and Purpose: Retinopathy of prematurity (ROP) is a complex disease. We have established much of the pathophysiology of this disease including the critical roles of retinal metabolic demand and vascular endothelial growth factor (VEGF). The purpose of this paper is to provide some background material and specifically highlight issues that are new, controversial, or underappreciated. Methods: ROP is subdivided into classification, incidence, screening, treatment, and co- morbidities. A brief background is given for each followed by highlighting specific problems attendant with current practices. Results: Disease classification is accurate, reliable, and extremely useful, and can be consistently applied. However, disease behavior can occasionally confound the classification system, such as Zone III ROP with previous Zone II disease as well as the temporal wedge seen in posterior ROP. Incidences of various ROP states are well known and consistent, but the true incidence of Zone I disease and plus disease are currently debatable. Screening guidelines are currently consensus products and, as such, may contain inaccuracies and have a lack of transparency to their recommendations. Treatment of ROP now involves intravitreal injections of anti- VEGF agents, primarily bevacizumab based on economic factors. However, it may not be the best agent when systemic safety is considered. The co- morbidities of retinal schisis and its impact on disease staging, and the poor prognosis associated with vitreous hemorrhage are notable. Conclusions: ROP has yielded up many of its secrets and clinician management continues to improve. However, our knowledge continues to evolve and more refinements are necessary.