Retinopathy of prematurity (ROP): optimal timing of clinical evaluation and standard procedures.

The authors present the protocol currently used in their institution for initial and follow-up evaluation of infants at high risk for developing retinopathy of prematurity (ROP). After topical anesthesia and lid speculum insertion, the examination is carried out using an indirect binocular ophthalmoscope with a +20 or +28-diopter lens. Mydriasis is achieved by instilling one drop of 1% tropicamide, followed by one drop of 0.5% tropicamide + 2.5% phenylephrine 15 minutes later and after an additional 15 minute interval, another drop of 1% tropicamide. If mydriasis is insufficient after one hour, one drop of a 0.5% tropicamide-5.0% phenylephrine solution may be instilled. The initial examination is performed between the third and fourth weeks of life. If any areas of retinal immaturity are found, the examination is repeated every other week and, later, every three to four weeks, until vascularization has reached the ora serrata. Should any sign of ROP be present during the first examination, the patient is examined weekly or every other week depending on the severity of clinical findings.