Retinopathy of prematurity (ROP)
It is a disease that occurs in prematurely born, underweight babies due to the immaturity of the developing retina. It is known to occur in 40% of premature babies.
Thus all babies born before the 34nd week or weighing less than 1800 gm are screened for ROP. Any baby declared as high risk by the neonatologist is also screened. The first screening takes place by 30 days of birth. The modalities for screening, available at our hospital are two wide field cameras that are unique in the aspect to screen small babies, by taking photographs of the retina:
- Retcam, which is a U. S. based digital camera system.
- Neo 3netra- a digital camera developed in India.
If any abnormality is found on screening, the doctor decides the severity of the disease based on the clinical pictures. As these are digital photographs, the retinal images are also shown to the parents, helping to make them understand the problem.
Treatment for ROP is given most commonly by laser therapy after using anaesthetic drops. In very advanced cases we also provide other options like intravitreal avastin therapy or vitrectomy surgery. Babies are continued to be checked till 3 years of age.
Our hospital is the fourth centre in India, and the only one in Maharashtra to have a dedicated ROP service, hence catering to population all over the state. Also, it is one of the only hospitals in India to provide surgery for advanced cases.
We run this program by extending services to various prime hospitals across Pune having an NICU support. Screening and laser treatment is provided during these visits. Also, Sassoon Hospital and Aundh Civil hospital are covered free of charge. Doctors from civil hospitals in five districts of Maharashtra- Thane, Nashik, Usmanabad, Nagpur and Pune, are given training in this institute, in collaboration with the government.
So far we have screened more than 10,000 babies, out of which more than 1000 babies have undergone laser therapy and enjoy good vision today. Intravitreal avastin therapy has been done in 100 babies. In cases with very advanced ROP, which is potentially blinding, we have carried out vitrectomy surgeries in 85 babies and prevented blindness.
Retina is a delicate multilayered film at the innermost posterior part of the eyeball which transmits light into nerve impulses and sends them to the brain via optic nerve for perception of visual images. Macula is the most sensitive part of the retina and is responsible for central vision. In the posterior segment, the eyeball is filled with a transparent gel like structure called the vitreous which helps in transmitting light to the retina and also maintains the structure of retina. Loss of clarity of vitreous can occur in a condition called vitreous haemorrhage (due to accumulation of blood). Grave conditions which can lead to up to total loss of vision are retinal detachment (neurosensory retina gets separated from retinal pigment epithelium) and hereditary and acquired macular diseases. Retinal diseases can not only affect adults but newborns as well. Premature babies are most prone to develop a condition called Retinopathy of prematurity which if not treated on time can progress to retinal detachment and eventual loss of vision. Retina can be affected by trauma and common medical conditions like diabetes , hypertension.
Various medical and surgical treatments are available for the above mentioned conditions. Complicated vitreo-retinal surgeries are performed successfully everyday. Various types of lasers and intravitreal injections are given to the patients in which it is indicated. Retinopathy of prematurity is also treatment with laser and intravitreal injections.
The retina department in H. V. Desai Eye Hospital is flourishing under the valuable guidance and experience of the head of department, Dr. Sucheta Kulkarni, who has an expertise in medical retina, public health and epidemiology.
Facilities available at H. V. Desai Hospital are:
- Retcam examination- Advanced high resolution imaging technology for consistency of reports to detect retinopathy of prematurity, detailed evaluation without long exposure of newborns to the examination procedure and documentation. Highly trained personal available for the use of such advanced technology.
- Ultrasonography- to view intraocular structures in opaque media and trauma.
- Fundus fluorescein angiography – to view leaking vessels, neovascularization and non perfused areas of the retina.
- Indocyanine green angiography- to view choroidal circulation
- Fundus photography- for detailed viewing and documentation of retinal images
- Optical coherence tomography- to evaluate retinal thickness in cases of edema, to detect macular holes, tumours, retinal detachment, epiretinal membrane and various other retinal diseases
- Electroretinography – to graphically represent functional capacity of the retinal cells.
- Visual evoked potential- used to measure electrical activity of visual system to detect mechanical and neural abnormalities related to vision.
- Various lasers are used to stabilise retinal diseases like diabetic retinopathy, vascular diseases, tumours, retinopathy of prematurity and many more. These are delivered either with the help of a slit lamp or by indirect ophthalmoscope. Diode, frequency doubled Nd:Yag laser and argon laser are available.
- Transpupillary thermotherapy is used in tumours to damage the abnormally growing vessels while causing minimal trauma to normal retina.
- Intravitreal injections- Intravitreal anti-VEGF injections are used to treat conditions in which there is growth of new abnormal leaky vessels due to underlying disease which has caused ischaemia of the retina. It can also be used in cases of macula edema. Intravitreal steroids can also be used to effectively treat macular edema. Intravitreal antibiotics are used to treat grave ocular infections to effectively deliver these drugs into the eyeball.
Pars plana vitrectomy with silicon oil or gas injection, core vitrectomy, epiretinal membrane peeling, macular hole surgery and intraocular foreign body removal are performed regularly in H. V. Desai eye hospital. Modern day surgeries use smaller size trocar/ cannula systems like 23G, 25G and 27G. These help in better wound reconstruction and healing and avoid post- operative infections. All the vitreous-retinal surgeries in H. V. Desai Eye Hospital are performed by highly educated skilled surgeons who have years of valuable experience in this field.