Treatments for Retinopathy of prematurity
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Book Excerpts: Treatment of Retinopathy of prematurity
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Retinal Hemorrhage:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Condition-dependent
–Treatment of underlying systemic disease is often the only treatment
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Laser and surgical intervention may be of benefit in diabetic retinopathy, vein occlusions, hypertensive retinopathy, Eales disease, retinal vascular tumors
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Prognosis depends on degree of retinal damage and neurologic involvement
-
Report suspect child abuse to state agency
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Retinal detachment:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment depends on the location and severity of the detachment. It may include restriction of eye movements and complete bed rest until surgical reattachment is done. A hole in the peripheral retina can be treated with cryothermy; in the posterior portion, with laser therapy. Retinal detachment usually requires a scleral buckling procedure or a vitrectomy to reattach the retina. Basic salt solution is used to replace the retina while the vitreous is removed.
Certain types of uncomplicated retinal detachment may be treated by pneumatic retinopexy, in which an expansile gas is initially injected into the vitreous cavity and the patient’s head is positioned to facilitate retina reattachment. This procedure can be performed under local anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Vascular retinopathies:
Treatment
(Professional Guide to Diseases (Eighth Edition))
No treatment has been shown to control central retinal artery occlusion. However, an attempt is made to release the occlusion into the peripheral circulation. To reduce intraocular pressure, therapy includes acetazolamide I.V., eyeball massage, thrombolysis by intra-arterial injection or I.V., high concentrations of inhaled oxygen, and anterior chamber paracentesis (to try to move the arterial obstruction into the peripheral field).
Therapy for central retinal vein occlusion may include aspirin, which acts as a mild anticoagulant. Patients with central retinal vein occlusion have reported improved vision after direct injection of tissue plasminogen activator into the retinal venous system. Laser photocoagulation can reduce the risk of neovascular glaucoma for some patients whose eyes have widespread capillary nonperfusion.
Treatment for nonproliferative diabetic retinopathy is prophylactic. Careful control of blood glucose levels may reduce the severity of the retinopathy or delay its onset. Patients with early symptoms of microaneurysms should have frequent eye examinations (three to four times per year); children with diabetes should have an annual eye examination.
Treatment for proliferative diabetic retinopathy or severe macular edema is laser photocoagulation, which cauterizes the leaking blood vessels. Laser treatment may be focal (aimed at new blood vessels) or panretinal (placing burns throughout the peripheral retina). Despite treatment, neovascularization continues to proliferate, and vitreous hemorrhage, with or without retinal detachment, may follow. If the blood isn’t absorbed in 6 weeks to 3 months, vitrectomy may restore partial vision.
Treatment for hypertensive retinopathy includes control of blood pressure with appropriate drugs, diet, and exercise. Treating the systemic hypertension should improve the condition of the eyes. If left untreated, hypertensive retinopathy results in severe vision loss.
The treatment goal of sickle cell retinopathy is to reduce the risk of, or prevent or eliminate, retinal neovascularization. Patients with symptoms should be followed twice a year with ocular examinations and dilated retinal evaluation. Proliferative disease should be treated with fluorescein angiography and panretinal photocoagulation. Cryotherapy hasn’t been proven to be effective and has a high complication rate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Retinal detachment:
Treatment
(Handbook of Diseases)
Depending on the location and severity of the detachment, treatment may include restriction of eye movements and complete bed rest to prevent further detachment.
A hole in the peripheral retina can be treated with cryothermy; in the posterior portion, with laser therapy. Retinal detachment usually requires scleral buckling to reattach the retina and, possibly, replacement of the vitreous with oil, air, gas, or silicone.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Vascular retinopathies:
Treatment
(Handbook of Diseases)
The following measures are used to treat vascular retinopathy.
Central retinal artery occlusion
No treatment has been shown to control central retinal artery occlusion. However, an attempt is made to release the occlusion into the peripheral circulation.
To reduce intraocular pressure, treatments include immediate ocular massage, anterior chamber paracentesis after anesthetizing the surface with topical cocaine 2% to 4% drops, acetazolamide 500 mg I.V., and inhalation of carbogen (95% oxygen and 5% carbon dioxide) to improve retinal oxygenation. Because inhalation therapy may be given hourly for up to 48 hours, the patient should be hospitalized so vital signs can be monitored.
If the patient is young, the source of the occlusion may be the heart. Echo-cardiography may be necessary. Treatment in this case is to heparinize the patient.
Central retinal vein occlusion
Therapy for central retinal vein occlusion may include aspirin, which acts as a mild anticoagulant. Laser photocoagulation can reduce the risk of neovascular glaucoma for some patients whose eyes have widespread capillary nonperfusion.
Diabetic retinopathy
Treatment of nonproliferative diabetic retinopathy is prophylactic. Careful control of blood glucose levels during the first 5 years of the disease may reduce the severity of the retinopathy or delay its onset.
Patients with early symptoms of microaneurysms should have frequent eye examinations (3 to 4 times a year); children with diabetes should have an annual eye examination.
Treatment for proliferative diabetic retinopathy is laser photocoagulation, which cauterizes the leaking blood vessels, thereby eliminating the cause of the edema. Laser treatment may be focal (aimed at new blood vessels) or panretinal (placing burns throughout the peripheral retina).
Despite treatment, neovascularization doesn’t always regress, and vitreous hemorrhage, with or without retinal detachment, may follow. Vitrectomy is the treatment of choice for vitreous hemorrhage to restore vision.
Hypertensive retinopathy
Treatment for hypertensive retinopathy includes control of blood pressure with appropriate drugs, diet, and exercise.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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