RETINOPATIJA NEDONOŠČADI - SUVREMENE SMJERNICE, DIJAGNOSTIKA I LIJEČENJE. (Croatian)

RETINOPATHY OF PREMATURITY - MODERN DIAGNOSTICS AND TREATMENT GUIDELINES. (English)

Retinopathy of prematurity (ROP) is a common blinding disease in children in the developed world despite current treatment, and is becoming increasingly prevalent in the developing word. ROP progresses in two phases. The first phase begins with delayed retinal vascular growth after birth and partial regression of existing vessels, followed by a second phase of hypoxia induced pathological vessel growth. Two major risk factors of ROP are the use of oxygen and a decreased gestation period. Hyperoxygenation contributes to the development of ROP by regulating vascular endothelial growth factor (VEGF). VEGF production is suppressed by high levels of oxygen in the first stage of ROP which prevents normal growth of blood vessels, while excess VEGF volume in another hypoxic phase induces pathological proliferation. The growth factor similar to insulin I (IGF-1) is the most important oxygen-non related risk factor of ROP development. CRYO ROP and ETROP studies demonstrate the efficacy of cryotherapy and laser photocoagulation in the treatment of children with RO. Laser photocoagulation is treatment of choice. Surgical treatment is recommended at later stages but has poor functional results. Children with this problem require long-term follow-up because of the possibility of developing complications. [ABSTRACT FROM AUTHOR]

Retinopatija nedonoščadi (ROP) je čest uzrok sljepoće u razvijenim zemljama usprkos metodama liječenja, a incidencija bolesti je, u razvijenim zemljama, u porastu. ROP se razvija u dvije faze. Prva faza počinje sa zakašnjelim razvojem krvnih žila retine nakon rođenja i parcijalnom regresijom postojećih krvnih žila, nakon čega slijedi druga faza - faza novog rasta krvnih žila induciranih hipoksijom. Dva su glavna čimbenika rizika za nastanak ROP-a: korištenje kisika i mala gestacijska dob. Pretjerana oksigenacija doprinosi razvoju ROP-a preko regulacije razina vaskularnog endotelijalnog čimbenika rasta (VEGF). Supresija VEGF kisikom u prvoj fazi ROP-a sprječava normalan rast krvnih žila, dok pretjerane količine VEGF-a u drugoj hipoksičnoj fazi potiču patološku proliferaciju. Inzulinu sličan čimbenik rasta I (IGF-1) je ključan faktor ROP-a koji nije povezan s oksigenacijom. Studije CRYO ROP i ETROP pokazuju učinkovitost krioterapije i laserske fotokoagulacije u liječenju djece sa ROP-om, a laserska fotokoagulacija je izbor u liječenju. Kirurško liječenje se primjenjuje kod kasnijih stadija, ali sa lošim funkcionalnim rezultatima. Djeca sa ovim problemom zahtijevaju dugoročno praćenje zbog mogućnosti razvoja komplikacija. [ABSTRACT FROM AUTHOR]

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