Disease Description (Causes and Symptoms)

Definition: Retinopathy of Prematurity (ROP) is a condition in which retinal blood vessels develop abnormally in premature infants, causing neovascularization and fibrous proliferation in the retina. In severe cases, it can progress to tractional retinal detachment.
Main causes/pathophysiology: Prematurity (lower gestational age) and low birth weight are the greatest risk factors. When retinal blood vessels are immature, changes in oxygen levels—especially high oxygen exposure—can cause vasoconstriction and vessel closure. Subsequently, abnormal angiogenesis and fibrosis develop as compensation for hypoxia. The extent and duration of ventilator use or oxygen therapy, anemia, and intracranial hemorrhage can also have an effect.
Symptoms: Most cases are asymptomatic in the early stages. As the condition progresses, strabismus and amblyopia may occur; in severe cases, vision loss due to retinal detachment and glaucoma may develop.

Treatment Methods

Screening and observation: Newborns with risk factors undergo regular ophthalmologic examinations early after birth (generally, the first examination is performed at 4–6 weeks after birth or at a specified point based on postmenstrual age (PMA)), followed by examinations every 1–2 weeks until retinal vascular development is complete. Many Stage 1–2 lesions resolve spontaneously.
Laser photocoagulation: Laser is applied to the avascular areas of the retina and is used as the standard treatment when progressive lesions meeting treatment criteria are present (e.g., progressive Stage 3 or higher, or plus disease).
Anti-VEGF injection (intravitreal anti-VEGF): Intraocular injections such as bevacizumab and ranibizumab may be used as selective or adjunctive treatment. Careful decision-making and long-term follow-up are necessary because of the possibility of effects from systemic absorption.
Surgical treatment: In cases of tractional retinal detachment (Stages 4–5), surgery such as vitrectomy may be necessary.
Supportive treatment/management: Individualized treatment may be needed, including prescription of eyeglasses for visual development, amblyopia treatment (patching), and treatment of complications such as strabismus and glaucoma.
Precautions: Because recurrence is possible after anti-VEGF treatment, long-term follow-up (ophthalmologic monitoring) is essential. Laser treatment may cause refractive errors (myopia) due to damage to the peripheral retina.

Items/documents to bring:
- Birth records (gestational age, birth weight)
- Summary of NICU admission records (duration of oxygen therapy and highest FiO2, whether a ventilator was used)
- Results and findings of previous ophthalmologic examinations (if available)
- List of current medications and history of allergies
- Eye-related symptoms observed by the parents (wandering or crossed eyes, reduced response to light, etc.)
Things to confirm in advance at the outpatient visit:
- Date and findings of the most recent ROP examination
- Whether there have been changes in neurodevelopment or general health
- History of eye-drop or injection treatment (anti-VEGF, laser, etc.)

"What follow-up examination schedule do you recommend? Until when should my child have ophthalmologic examinations?"
"What are the advantages, disadvantages, and side effects of the treatments offered (laser/anti-VEGF)?"
"How might this condition affect my child's long-term visual prognosis?"

"Considering my baby's gestational age at birth (or weight) and the duration of oxygen therapy, what stage and level of risk does the baby currently have? Is immediate treatment necessary?"
"Between laser treatment and anti-VEGF injection, which treatment is more appropriate for my baby, and what will the recurrence and follow-up plan be after treatment?"