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Retinopathy in premature babies: a few steps on the road to recovery

Childbearing time is a significant period in the life of every woman. The organism of the future man is forming, but sometimes the fetus stays in the mother's womb is marked by various difficulties, the consequences of which are revealed later. Such problems include retinopathy, which is often found in premature babies. How to prevent the occurrence of pathology and cope with it, if the disorder is already detected?

Content

What is retinopathy in premature babies?

Retinopathy is a pathological condition in which the development of the retina is impaired . While the fetus is in the womb, nothing threatens its state. Premature birth leads to the termination of the process of formation of the organism, so some organs are not fully developed. As a result, there are no blood vessels in the baby’s eyeballs, which can further lead to loss of vision due to retinal detachment.

Retinopathy in premature babies

Retinopathy in premature babies is associated with impaired vascular formation in the eyeball.

The child’s body seeks to compensate for this deficiency by triggering recovery mechanisms. However, due to the weakness of the newly formed vessels, they are likely to rupture, which increases the risk of hemorrhages and other complications.

It is interesting! The retinal vessels begin to form at 15–16 weeks of gestation, and by 36–40 weeks, development ends.

According to statistics, about 20% of children born prematurely have retinopathy. Severe pathology is found in 8% of cases.

Retinopathy Development Video

Classification of pathology

There are 2 forms of retinopathy - active and scar. In the first situation, the possibility of self-healing remains, if the baby develops correctly, he is provided with the necessary care, and the retina continues to form. In the case of the cicatricial form, the projections are not always favorable - one cannot do without surgical intervention.

Pathology is characterized by 5 stages of development:

  1. Active Form:
    • Stage 1 - there is a separation (demarcation) line, which is located between the mature retina and the area without vessels;
    • Stage 2 - the dividing line begins to thicken and becomes coarse. Formed crest, towering above the retina;
    • Stage 3 - new vessels are formed, germinating to the center of the eye. In normal development, this does not occur.
  2. Cicatricial form:
    • Stage 4 - the beginning of retinal detachment. The vitreous body changes, making it opaque, transforming into a scar;
    • Stage 5 - complete detachment of the retina. The pupil expands, which acquires a grayish tint.
Stages of retinopathy

With typical development of retinopathy, the disease consistently passes through 5 stages.

In addition, every fourth child with retinopathy develops a malignant form of pathology. It is represented by rapid development, and the division into stages is weakly expressed. The following types are characteristic of an atypical form:

  • aggressive rear form - pathology with rapid development, is the greatest danger to the child. Retinopathy in this case is associated with the proliferation of blood vessels before the appearance of the dividing line. It occurs in 15-30% of cases, while the effectiveness of treatment is 50%;
  • pre- “plus disease” is a borderline between developed vessels and pathological changes characteristic of plus-disease. Presented by increased vascular activity;
  • "Plus disease" is an accelerated form with a rapid course of the active phase, culminating in retinal detachment and other complications.

Note! With typical development of retinopathy, the first changes are noticeable a month after birth. Symptoms appear gradually: the disease reaches stage 3 in 4 months, and the beginning of the scar form accounts for 1 year.

Causes and risk factors

For a long time, experts believed that the cause of the retinopathy of premature infants was related to the presence of the baby in the incubator - a special device for nursing a child. At this stage, the baby is given oxygen, the concentration of which reaches high values. Because of this, metabolic processes in the retina are disturbed, so it is replaced by connective and scar tissue. Official statistics added fuel to the fire: the largest number of children with retinopathy is found in countries with advanced medicine.

To date, it has been revealed that a baby’s stay in an incubator and a high concentration of oxygen are not the only reasons for the formation of pathology. The development of the organs of vision of the child also affect:

  • genetic predisposition;
  • bad habits of the mother during gestation;
  • exposure to sunlight and ambient light on the unformed retina of the newborn.

Risk factors are:

  • long stay in the incubator - more than 3 days;
  • body weight less than 1400 g;
  • complications during childbirth: injuries, cerebral hemorrhage, asphyxia and hypoxia;
  • infections transmitted by the mother during pregnancy;
  • birth at 26–28 weeks;
  • pathology of head vessels, as well as respiratory, nervous and circulatory systems.
Cuvez

Long stay of the child in the incubator is one of the causes of retinopathy

Symptoms of pathology

Signs indicating retinopathy are difficult to detect in a timely manner. This is due to the fact that the symptoms of pathology rarely appear immediately after the birth of the baby, therefore, children born before the scheduled time are required to be examined by an ophthalmologist.

The first signs of retinopathy

Despite the difficulties in detecting symptoms, there are still peculiar signals that can be used to determine the need to go to a doctor. The first reasons for concern are the following signs:

  • the baby observes objects with one eye;
  • strabismus, which was previously absent;
  • closing one eye does not cause concern, but if forcibly closing the second, then the crumb begins to be capricious;
  • the baby does not notice distant objects and does not pay attention to them;
  • child brings toys and other objects close to the eyes;
  • blinking is carried out with one eye (can be observed constantly).

Symptoms by stage of development of the disease - table

Stages Symptoms
1
  • decreased visual acuity;
  • strabismus appears.
2
  • strabismus develops;
  • vision deteriorates;
  • hemorrhages occur.
3
  • deformed optic nerve;
  • the central plane of the retina shifts;
  • hemorrhages are observed;
  • there are painful sensations.
4
  • vision continues to deteriorate (changes are significant);
  • a veil appears before the eyes;
  • hemorrhages and displacement of the retina increase.
5
  • funnel-shaped or folded due to retinal detachment;
  • glaucoma occurs due to the impossibility of outflow of fluid;
  • there is no reaction to light stimuli, the child does not focus his eyes on objects.

Diagnosis of pathology

To detect the disorder, you should visit an ophthalmologist. During the examination, the drug Atropine is used, aimed at the expansion of the pupil. For the fixation of the eyelids, child extenders are used to make the diagnosis convenient and safe for both the doctor and the child. After the performed actions, a binocular ophthalmoscopy apparatus is used, which helps to register pathological changes.

Note! It is advisable to carry out the examination when the child reaches the age of 3-4 weeks, when the first noticeable changes in the typical form of retinopathy appear, but there is an exception - an atypical type of pathology, the symptoms of which may occur more quickly.

In addition to the above research method, other methods can be used:

  • ultrasound diagnostics - prescribed for extensive hemorrhages or clouding of the vitreous glass, as these factors interfere with the examination by other means;
  • digital retinoscopy - study the condition of the eye vessels;
  • electroretinography - assess the functional state of the retina;
  • optical coherence tomography - examines the membranes of the eyes.

It is recommended to visit the doctor every 2 weeks, which will allow you to identify unwanted changes in a timely manner. If retinopathy was diagnosed, then the frequency of studies will depend on the type of pathology and the patient's condition:

  • active form - every week;
  • rear aggressive form and "plus disease" - every 3 days;
  • disease regress - once every 6–12 months until the child reaches 18 years of age (to rule out complications);
  • recurrence of the disease - once a year.
Diagnosis of retinopathy

The frequency of diagnosis of retinopathy depends on the form and stage of the disease.

Treatment of retinopathy of prematurity

Currently, there is no single approach to the treatment of retinopathy of prematurity, since this process depends on many conditions. Some doctors suggest that surgery is necessary in 3 stages, and in the initial stages, observation and conservative therapy are required. Their opponents insist on an earlier intervention of the surgeon for the purpose of prophylaxis - by 2, and then by 1 stage.

Nevertheless, the first point of view prevails. The fact is that at the initial phases of the development of retinopathy there is a high probability of regression of the pathology, it is only necessary to monitor the condition of the child. Therefore, the use of a surgical method of treatment is advisable in 3 and subsequent stages, when the reverse process of development is unlikely.

Conservative treatment

The conservative method is suitable for the treatment of early (1-2) stages of retinopathy. In order to maintain the health of the child, the following groups of drugs are used:

  1. Hormonal drops (Maxidex, Prenacid, Dexamethasone). Used in the activation of the pathological process.
  2. Antioxidants (Ascorbic acid, Emoksipin). Used to protect the walls of blood vessels of the eye from the negative effects of oxygen.
  3. Angioprotectors (Ditsinon, Etamzilat). Assigned to strengthen the blood vessels, preventing hemorrhages in the vitreous body and retina.

Note! The use of drug therapy is complicated by the age of the patients, since it is difficult to find a suitable dose of the drug for treating a small child, therefore, it is not allowed to use such drugs on your own without the permission of a doctor!

During conservative treatment, preparations containing vitamin E are also used. Although experts have not revealed its effectiveness in preventing pathology, the use of such agents may be justified, since they help to reduce the severity of the disease. In addition, drugs with vitamin E have antioxidant properties, which together with other drugs will help to achieve a positive result. An example of such a remedy is Alpha-Tocopherol acetate.

During the regression of the pathology or during recovery after retinopathy, physiotherapy may be prescribed. In this case, use the following methods:

  • magnetic stimulation - improves the recovery process;
  • electrophoresis with antioxidants - increases the degree of penetration of these drugs;
  • electrical stimulation - normalizes the process of metabolism and improves blood supply to the eyeball.

An additional method of treatment is a massage, prescribed also after regression of retinopathy. The procedure is carried out 10-15 minutes a day. The presented technique is appointed by the pediatrician and only with the permission of the oculist.

Photo gallery of drugs for the treatment of retinopathy

Surgical intervention

After achieving pathology stage 3, the question arises about the appointment of surgical intervention. In this case, doctors can use the following methods of surgery:

  • cryosurgical coagulation is the use of liquid nitrogen in those parts of the retina in which vessels have not yet arisen. As a result, the scar tissue ceases to form, retinopathy begins to regress;
  • laser coagulation - the creation of a scar in the problem area of ​​the retina, which becomes an obstacle to the growth of blood vessels. This technique is preferable to cryosurgical coagulation, since the use of a laser is less dangerous and is rarely accompanied by side effects;
  • Circular sealing of the sclera - the use of the so-called patch at the site of detachment of the retina, after which the retina is tightened to this area;
  • transciliary vitrectomy - excision of the vitreous body modified by pathology and scars that have arisen on the surface of the retina. This allows you to achieve a weakening of the degree of tension and incomplete detachment - it helps to preserve vision partially. If the detachment was complete, then the probability of a favorable outcome is very small.
Laser coagulation

Laser coagulation helps prevent vascular proliferation

Treatment predictions

In 80% of cases of development of 1-2 stages of retinopathy, the disease passes successfully on its own. During this period, it is enough to keep the situation under control by regularly visiting a doctor for diagnosis.

There is still a high probability of recovery at the 3 stage of pathology, where laser or cryosurgical coagulation can be successfully used. The effectiveness of these methods depends on the time of the intervention: if the operation is performed within 2 days after the detection of retinopathy, then the probability of a favorable outcome reaches 50-80%.

When reaching stage 4, scleral sealing is used, and in case of successful completion of the intervention, the baby's vision improves markedly. If the method did not help, then there remains a vitrectomy, the effectiveness of which also depends on the time of the procedure: the earlier the operation is performed, the more chances the child has to maintain vision.

Note! The most effective surgery has in the first year of life of the baby.

At stage 5, there are significant changes, so after the successful completion of treatment, the child will be able to navigate in space and follow objects that are very close, but no more.

Consequences and complications

Even after successful completion of the operation, the likelihood of complications remains. The risk of the onset of adverse events is especially high with untimely initiated therapy or after a severe course of retinopathy. These consequences can be:

  • glaucoma;
  • eye dystrophy;
  • strabismus;
  • cataract;
  • retinal disinsertion;
  • myopathy (myopia);
  • amblyopia - visual impairment, which cannot be corrected by lenses and glasses;
  • astigmatism.
Glaucoma

Glaucoma is one of the consequences of delayed or incorrect treatment of retinopathy.

Therefore, after treatment, the child should be under the supervision of specialists who will conduct regular diagnostics.

Note! The reason for applying for a disability is the inconsistency of the child’s visual acuity with the established norms, especially after the therapeutic measures taken.

Preventive actions

Preventive measures are similar to actions taken to prevent the development of other pathological processes. It is necessary:

  • visit a doctor regularly to monitor the condition of the baby;
  • to lead a healthy lifestyle, especially for the expectant mother;
  • avoid during pregnancy loads and stresses that can cause premature birth.

It is important! If after the birth of a child into the world there is a need to use oxygen therapy, the exercise is carried out with the mandatory control of the degree of oxygen saturation - it is impossible to allow exceeding the permissible concentration values.

The health of the child is in the hands of his parents, therefore it is impossible to allow the situation to deteriorate when it comes to the most expensive. When the first symptoms appear, they immediately seek help from a doctor, because waiting for the appearance of serious signs is a dangerous event.

Interesting

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