Restricting supplemental oxygen use reduces the rate of ROP, but may raise the risk of other hypoxia-related systemic complications, including death.Patients with ROP, particularly those who have developed severe disease needing treatment are at greater risk for strabismus, glaucoma, cataracts and shortsightedness (myopia) later in life and should be examined yearly to help prevent or detect and treat these conditions. Diagnosis
The stages of ROP disease have been defined by the International Classification of Retinopathy of Prematurity (ICROP). In older patients, the appearance of the disease is less well described but includes the residua of the ICROP stages as well as secondary retinal responses. International classification
The system used for describing the findings of active ROP is entitled The International Classification of Retinopathy of Prematurity (ICROP). ICROP uses a number of parameters to describe the disease. They are location (zone) of the disease, the circumferential extent of the disease based on the clock hours, the severity (stage) of the disease and the presence or absence of "Plus Disease". Each aspect of the classification has a technical definition. This classification was used for the major clinical trials. It was revised in 2005. The zones are centered on the optic nerve. Zone I is the posterior zone of the retina, defined as the circle with a radius extending from the optic nerve to double the distance to the macula.
Furthermore, recent trials have shown that treatment at an earlier stage of the disease gives better results. Scleral buckling and/or vitrectomy surgery may be considered for severe ROP (stages 4 and 5) for eyes that progress to retinal detachment. Few centers in the world specialize in this surgery, because of its attendant surgical risks and generally poor outcomes. Intravitreal injection of bevacizumab (Avastin) has been reported as a supportive measure in aggressive posterior retinopathy of prematurity. In a 2011 clinical trial comparing bevacizumab with conventional laser therapy, intravitreal bevacizumab monotherapy showed a significant benefit for zone I but not zone II disease when used to treat infants with stage 3+ retinopathy of prematurity. Potential benefits of intravitreal Avastin injection over laser therapy include: reduction in level of anesthesia required, preservation of viable peripheral retina, and, possibly, reduced incidence of subsequent high refractive error. However, the safety of this new treatment has not yet been established in terms of ocular complications as well as systemic complications. The latter are theoretically possible, as the active ingredient of bevacizumab not only blocks the development of abnormal blood vessels in the eye but may also prevent the normal development ofother tissues such as the lung and kidney. A 2018 Cochrane review also examined the effectiveness of Anti-vascular Endothelial Growth Factor Drugs and their use for ROP. Oral propranolol is being evaluated for counteracting the progression of ROP, but safety is a concern.