Rishi Desai, MD, MPH

Retinopathy of prematurity

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Chapter 77 Globe Pathlogy  RETINOPATHY OF PREMATURITY osms.it/retinopathy-of-prematurity PATHOLOGY & CAUSES ▪ AKA retrolental ﬁbroplasia ▪ Proliferative retinopathy, occurs in preterm infants; if untreated → vision loss ▪ Common cause of childhood blindness ▪ Premature birth interrupts development → ↑ risk of vascular insult ▪ Supplemental oxygen administration → disruption of normal angiogenesis → abnormal growth of blood vessels, ﬁbrous tissue affecting temporal part of retinal periphery ▪ Regress spontaneously in most cases  RISK FACTORS  ▪ Gestational age < 30 weeks; birth weight ≤ 1.5kg/3.3lbs; excessive oxygen therapy; supplemental oxygen  COMPLICATIONS  ▪ Retinal bleeding, scarring ▪ Contraction of ﬁbrovascular tissue → retinal detachment → blindness ▪ Refractive errors: myopia, anisometropia ▪ Squint/strabismus ▪ Glaucoma  SIGNS & SYMPTOMS ▪ Blindness due to retinal detachment, if untreated  ▪ Classiﬁcation ▫ Location: three concentric zones from optic disc to periphery ▫ Extent: retina divided in 12 parts (hours of a clock) ▫ Stage I: thin white demarcation line separating vascularized from avascular retina ▫ Stage II: ridge of ﬁbrous tissue into vitreous between vascularized, avascular retina ▫ Stage III: abnormal growth of ﬁbrovascular tissue on ridge; extension into vitreous ▫ Stage IV: partial retinal detachment ▫ Stage V: total retinal detachment ▫ Plus disease: increased venous dilation, tortuosity of posterior retinal vessels, vitreous haze  OTHER DIAGNOSTICS  ▪ Screening of preterm infants  TREATMENT MEDICATIONS  ▪ Intravitreal injection of VEGF antagonists  SURGERY  ▪ Ablation of retina with laser photocoagulation  DIAGNOSIS DIAGNOSTIC IMAGING Fundoscopy ▪ Direct/indirect following pupil dilation ▫ Disorganized growth of vessels, ﬁbrous tissue  OSMOSIS.ORG 609   

Bones of the cranium

Anatomy of the cranial base

Anatomy of the orbit

Anatomy of the eye

Anatomy of the nose and paranasal sinuses

Anatomy of the oral cavity

Anatomy of the temporomandibular joint and muscles of mastication

Muscles of the face and scalp

Anatomy of the salivary glands

Nerves and vessels of the face and scalp

Anatomy of the tongue

Anatomy of the pterygopalatine (sphenopalatine) fossa

Anatomy of the inner ear

Anatomy of the infratemporal fossa

Anatomy of the external and middle ear

Anatomy clinical correlates: Skull, face and scalp

Anatomy clinical correlates: Ear

Anatomy clinical correlates: Eye

Anatomy clinical correlates: Temporal regions, oral cavity and nose

Head

Bones of the neck

Superficial structures of the neck: Posterior triangle

Superficial structures of the neck: Cervical plexus

Superficial structures of the neck: Anterior triangle

Deep structures of the neck: Prevertebral muscles

Anatomy of the thyroid and parathyroid glands

Anatomy of the larynx and trachea

Anatomy of the pharynx and esophagus

Anatomy of the lymphatics of the neck

Fascia and spaces of the neck

Anatomy clinical correlates: Bones, fascia and muscles of the neck

Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck

Anatomy clinical correlates: Viscera of the neck

Neck

Introduction to the cranial nerves

Cranial nerve pathways

Anatomy of the olfactory (CN I) and optic (CN II) nerves

Anatomy of the oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Anatomy of the trigeminal nerve (CN V)

Anatomy of the facial nerve (CN VII)

Anatomy of the vestibulocochlear nerve (CN VIII)

Anatomy of the glossopharyngeal nerve (CN IX)

Anatomy of the spinal accessory (CN XI) and hypoglossal (CN XII) nerves

Anatomy of the vagus nerve (CN X)

Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves

Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Anatomy clinical correlates: Trigeminal nerve (CN V)

Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves

Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves

Cranial nerves

Anatomy

Development of the face and palate

Pharyngeal arches, pouches, and clefts

Development of the ear

Development of the eye

Embryology

Eye and ear histology

Nasal cavity and larynx histology

Thyroid and parathyroid gland histology

Histology

Anatomy and physiology of the eye

Photoreception

Optic pathways and visual fields

Anatomy and physiology of the ear

Auditory transduction and pathways

Vestibular transduction

Vestibulo-ocular reflex and nystagmus

Olfactory transduction and pathways

Taste and the tongue

Special senses

Thyroid hormones

Phosphate, calcium and magnesium homeostasis

Parathyroid hormone

Vitamin D

Calcitonin

Thyroid and parathyroid glands

Physiology

Color blindness

Cortical blindness

Hemianopsia

Homonymous hemianopsia

Bitemporal hemianopsia

Cataract

Glaucoma

Retinal detachment

Age-related macular degeneration

Diabetic retinopathy

Corneal ulcer

Retinoblastoma

Periorbital cellulitis

Uveitis

Keratitis

Orbital cellulitis

Hordeolum (stye)

Conjunctivitis

Neonatal conjunctivitis

Eye disorders

Conductive hearing loss

Eustachian tube dysfunction

Tympanic membrane perforation

Otitis externa

Otitis media

Ear disorders

Vertigo

Meniere disease

Labyrinthitis

Acoustic neuroma (schwannoma)

Vestibular disorders

Choanal atresia

Allergic rhinitis

Nasal polyps

Nasopharyngeal carcinoma

Nasal and nasopharyngeal disorders

Sialadenitis

Parotitis

Ludwig angina

Aphthous ulcers

Temporomandibular joint dysfunction

Oral cancer

Warthin tumor

Sleep apnea

Gastroesophageal reflux disease (GERD)

Zenker diverticulum

Retropharyngeal and peritonsillar abscesses

Esophageal cancer

Oral cavity and oropharyngeal disorders

Laryngomalacia

Laryngitis

Bacterial epiglottitis

Laryngeal disorders

Thyroglossal duct cyst

Thyroid cancer

Hyperparathyroidism

Hypoparathyroidism

Thyroid and parathyroid gland disorders

Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review

Retinopathy of prematurity

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