A review on retinopathy of prematurity.

Abstract

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. It predominantly affects preterm infants with very low birth weights or extreme prematurity. Aberrant retinal vascular development, driven by hyperoxia and hypoxia-induced neovascularization, is central to ROP pathogenesis. This review explores the relationship between maternal health and ROP, evaluates current prevention strategies, assesses innovations in diagnostic and screening technologies, reviews contemporary treatments, and identifies future research directions.

Methods: A literature review was conducted in the PubMed / MEDLINE, Scopus, Web of Science, and Google Scholar databases using related keywords, i.e., "retinopathy of prematurity," "retinal development," "pathophysiology," "vascular growth," "complications," "visual outcomes," "maternal health factors," "obstetrics," "preeclampsia," "risk factors," "preterm birth," "corticosteroids," "oxygen management," "treatment strategies," "laser therapy," "anti-VEGF agents," "surgical approaches", and "artificial intelligence (AI)" and targeting English studies published in the last 20 years. Additionally, the references from the selected articles were manually reviewed. Clinical trials, meta-analyses, systematic reviews, case-control studies, case series, narrative reviews, pilot studies, and relevant animal studies were included.

Results: Maternal factors, such as diabetes, smoking, and preeclampsia, along with neonatal factors, such as low gestational age and extreme prematurity, are critical contributors to ROP. Key preventative strategies to reduce the risk of ROP and improve neonatal outcomes include: 1. prenatal care involves screening and managing maternal conditions, providing maternal education, and administering antenatal corticosteroids. 2. Neonatal care encompasses nutritional support, supplementation with essential fatty acids, and regulated oxygen administration. By focusing on these strategies, we can enhance the health of newborns at risk for ROP. Advances in screening, including artificial intelligence (AI)-assisted diagnostics and advanced imaging, are improving early detection. Treatment modalities such as laser photocoagulation, cryotherapy, and anti-vascular endothelial growth factor therapies have shown promise but pose challenges, including recurrence risk and systemic side effects.

Conclusions: ROP continues to pose a major threat to the vision of preterm infants, particularly in regions with limited healthcare resources. Addressing ROP requires multidisciplinary team approaches that integrate obstetric and neonatal care. Preventative strategies, including prenatal care optimization, oxygen management, and nutritional support, are essential. Future efforts should focus on integrating emerging technologies and recent findings to ensure global relevance and currency.