RETINOPATHY OF PREMATURITY: EVALUATION AND MANAGEMENT

Abstract

Introduction: Retinopathy of prematurity is a significant challenge in neonatology and pediatric ophthalmology, representing one of the main causes of preventable blindness in childhood. This complex condition affects preterm newborns due to incomplete retinal vascular development, making them vulnerable to external stimuli such as oxygenation. Disease progression can vary widely, from mild alterations that regress spontaneously to severe forms that lead to retinal detachment. The management of ROP required an in-depth understanding of its stages and associated risk factors, such as low birth weight and reduced gestational age. Objective: The objective of this systematic literature review was to synthesize the available scientific evidence on diagnostic evaluation methods and therapeutic approaches for retinopathy of prematurity. Methodology: The methodology was based on the recommendations of the PRISMA checklist for conducting systematic reviews. The search was performed in the electronic databases PubMed, SciELO and Web of Science, using a combination of the following descriptors: "Retinopathy of Prematurity", "ROP", "Diagnosis", "Assessment", "Treatment". Original studies published in the last 10 years that addressed the evaluation and/or management of ROP in human populations were included. Isolated case reports, review articles (except the basis for the systematic review itself) and publications that did not directly focus on retinopathy of prematurity were excluded. Results: The results highlighted the crucial importance of regular ophthalmological examination in at-risk newborns, typically performed by experienced ophthalmologists using indirect ophthalmoscopy. Recent studies have also highlighted the increasing role of digital retinography as a complementary tool in the evaluation. Regarding management, laser photocoagulation remained the standard treatment for high-risk threshold or pre-threshold disease. Furthermore, the use of intravitreal anti-VEGF agents has emerged as a promising alternative, especially for later aggressive forms of the disease. Conclusion: In conclusion, early and continuous evaluation, combined with therapeutic management based on current evidence, has proven to be essential for the visual prognosis of infants with retinopathy of prematurity. Indirect ophthalmoscopy remains essential, while new technologies and therapies, such as anti-VEGFs, have expanded management options, aiming to minimize long-term visual sequelae. Research in this area continues to seek to optimize screening, risk stratification, and interventions.