Questions
Q1. What is Type 1 ROP according to Early Treatment ROP study?
a) Zone 1 stage 3 with or without plus disease
b) Zone 1 any ROP with plus disease
c) Zone 2, stage 2 or 3 with plus disease
d) All of the above
Q2. Plus disease is defined as dilation and tortuosity of the posterior retinal blood vessels in at least how many quadrants?
a) 1 quadrant
b) 2 quadrants
c) 3 quadrants
d) 4 quadrants
Q3. What are the features of Aggressive posterior ROP?
a) Rapidly progressive Zone1 posterior ROP
b) Rapidly progressive Zone1 posterior ROP with plus disease in all 4 quadrants
c) Rapidly progressive Zone1 posterior ROP with plus disease in all 4 quadrants with featureless junction between vascularized and avascular retina.
d) None of the above
Q4. Which are the cytokines raised in pathogenesis of ROP?
a) VEGF
b) IL-6
c) TGF-B
d) a and c
Q5. What are the factors responsible for development of Crunch phenomenon leading to development of retinal detachment in ROP?
a) Iatrogenic rise in TGF-B
b) Endogenous rise in TGF-B
c) Both a and b
d) Rise in anti- VEGF alone
QuizWise Responses
Ans1) d. all of the above
The Early Treatment for Retinopathy of Prematurity (ETROP) study defined type 1 ROP as zone 1, stage 3 ROP; zone 1, any ROP with plus disease; or zone 2, stage 2 or 3 ROP with plus disease.
Hansen, Eric & Hartnett, Mary. (2019). A review of treatment for retinopathy of prematurity. Expert Review of Ophthalmology. 14. 1-15. 10.1080/17469899.2019.1596026.
DOI:10.1080/17469899.2019.1596026.
Ans2) b 2 quadrants
Hubbard GB 3rd. Surgical management of retinopathy of prematurity. Curr Opin Ophthalmol. 2008;19(5):384‐390. doi:10.1097/ICU.0b013e328309f1a5. DOI:10.1097/ICU.0b013e328309f1a5
Ans3) c
APROP is defined as an uncommon, rapidly progressing, severe form of
ROP. The characteristic features are its posterior location (usually zone I but also posterior
zone II), prominent plus disease in all 4 quadrants out of proportion to the more peripheral
findings, and a deceptively featureless junction between vascularized and avascular retina.
Hubbard GB 3rd. Surgical management of retinopathy of prematurity. Curr Opin Ophthalmol. 2008;19(5):384‐390. doi:10.1097/ICU.0b013e328309f1a5. DOI:10.1097/ICU.0b013e328309f1a5
Ans4) d both a and c.
The dynamic cytokine milieu of the developing retina is complex and not fully understood yet. Vascular endothelial growth factor and many other cytokines are involved in ROP pathogenesis. Anti-VEGF injections alter multiple cytokines, including elevation of TGF-b, a potent profibrotic agent
Yonekawa Y, Thomas BJ, Thanos A, Todorich B, Drenser KA, Trese MT, Capone A
Jr. THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE: Expanding the Boundaries
of Diagnosis and Treatment. Retina. 2017 Dec;37(12):2208-2225. doi:
10.1097/IAE.0000000000001719. Review. PubMed PMID: 28541957.
Review article 37:2208–2225, 2017
Ans5) c. Both a and b.
Iatrogenic rise in TGF-b may occur after giving anti VEGF injections. Premature infants experience an endogenous rise of TGF-b as they approach term. This unopposed TGF-b can cause rapid contraction of the fibrovascular membranes to cause progressive retinal detachment. Such “crunching” has been most commonly discussed in proliferative diabetic retinopathy but has been reported in ROP as well.
Example of crunching phenomenon leading to development of RD after anti-VEGF injection in APROP is shown below.
Crunch phenomenon after anti-VEGF treatment. A. Circumferential type of anti–VEGF-associated progressive retinal detachment, which was noted 1 week after bevacizumab for an infant with aggressive posterior ROP.
B. Pre papillary type of anti–VEGF-associated progressive posterior retinal detachment that was noted several weeks after bevacizumab for Zone I disease.
Yonekawa Y, Thomas BJ, Thanos A, Todorich B, Drenser KA, Trese MT, Capone A Jr. THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE: Expanding the Boundaries of Diagnosis and Treatment. Retina. 2017 Dec;37(12):2208-2225. doi10.1097/IAE.0000000000001719. Review. PubMed PMID: 28541957.Review article 37:2208–2225, 2017