ROP became the most common cause of blindness in children in industrialized nations in Europe and North America during the late 1940s and 1950s, after the introduction of intensive neonatal care. Despite many advances in different areas, such as screening and treatment of ROP, one-half a century later ROP remains one of the major causes of blindness among children in middle-income countries that have recently introduced neonatal intensive care service for preterm and low-birth-weight infants.98 Several factors have hindered the effort in halting the disease. The underlying pathophysiological process is not yet well-known. It is not always possible to stop the aggressive nature of ROP, even if the disease is detected early. The resources needed for proper management of ROP are not widely available. Nevertheless, the progress in ROP has not been insignificant. This chapter has attempted to highlight some of the recent knowledge about ROP and advances in the management of this disease. Additional information is known about the incidence and racial variation in the severity of ROP. Also, newly available information may shed more light on the pathophysiology of ROP. Recent results of the STOP-ROP study indicate that oxygen supplemental therapy, when used at certain oxygen level, does not lead to progression of ROP. However, other information derived from the STOP-ROP study also are evaluated critically; data from this study may imply that oxygen can be beneficial for ROP. The roles of surfactant and dexamethasone, often given for respiratory distress syndrome in premature infants, in the progression of ROP, also were examined in detail. The management of ROP has consisted of cryotherapy, laser photocoagulation, and vitreoretinal surgery. Recent data about diode laser therapy were mentioned. Early intervention, medically or surgically, when appropriate, again was emphasized. The potential benefits of lens-sparing vitrectomy, low-molecular-weight heparin, and high-resolution ultrasonography were discussed. Because the medical profession and medicine have changed drastically during the last 5 years in terms of medical care cost, the cost-effectiveness in the management of ROP also was mentioned.
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