| Abstract | Retinopatija nedonoščadi (engl. retinopathy of prematurity - ROP) razvojni je poremećaj krvnih žila mrežnice te prvi uzrok sljepoće u Hrvatskoj do 16 godina. Bolest se klasificira prema međunarodnoj klasifikaciji retinopatije nedonoščadi, a ta klasifikacija uključuje kategorizaciju bolesti u pet stupnjeva, lokalizaciju bolesti prema zonama, proširenosti koju određujemo u odnosu na kazaljke na satu te prisutnosti ili odsutnosti takozvane (pre)plus-bolesti. Prema dosadašnjim istraživanjima i spoznajama bolest se smatra multifaktorijalnom pa ne čudi veliki broj rizičnih čimbenika od kojih su neki niska porođajna masa, niska gestacijska dob, primjena strojne ventilacije duža od tjedan dana, sepsa i mnogi drugi. Kako bismo na vrijeme otkrili i dijagnosticirali bolest, jako je važan probir i praćenje nedonoščadi koja su pod određenim rizikom za razvoj bolesti. Postoje razne preporuke i kriteriji uključivanja u program probira, a temelje se na porođajnoj masi i gestacijskoj dobi. Dijagnostika se provodi pregledom pomoću binokularne indirektne oftalmoskopije lećom od 28 dioptrija. U novije vrijeme razvijaju se i mnogi digitalni načini praćenja koji ipak nisu dovoljno dobri da bi mogli zamijeniti tradicionalne načine. Patogeneza bolesti izrazito je složena te uključuje dvije faze od kojih je prva vazoobliterativna, a druga proliferativna. Rođenjem nedonoščeta mijenja se okolina te dijete prelazi iz maternice u kojoj je dobivalo kisik pod manjim parcijalnim tlakom u okolinu s puno većim parcijalnim tlakom što prvotno dovodi do prestanka rasta krvnih žila mrežnice. Rastom djeteta rastu i zahtjevi za kisikom pa dolazi do ponovne i agresivne nepravilne proliferacije krvnih žila mrežnice što se događa pod utjecajem IGF-1 i VEGF. Postoje i mnogi drugi patogenetski mehanizmi ovog procesa, a koji su obrađeni u ovome radu. Poznavanje patogenetskih procesa pomaže nam u razumijevanju, lakšem dijagnosticiranju te liječenju bolesti, što dovodi do smanjena broja najgorih komplikacija ove bolesti, ablacije retine i sljepoće. |
| Abstract (english) | Retinopathy of prematurity (ROP) is a developmental disorder of blood vessels in the retina and the first cause of blindness in Croatia under the age of 16. The disease is classified according to the international classification of retinopathy of prematurity, and this classification includes the categorization of the disease into five stages, the localization of the disease according to zones, the extension determined in relation to the hands of the clock, and the presence or absence of the so-called (pre)plus-disease. According to previous research and knowledge, the disease is considered multifactorial, so it is not surprising that there are a large number of risk factors, some of which are low birth weight, low gestational age, use of mechanical ventilation for more than a week, sepsis and many others. In order to detect and diagnose the disease in time, it is very important to screen and monitor premature babies who are at a certain risk of developing the disease. There are various recommendations and criteria for inclusion in the screening program, based on birth weight and gestational age. Diagnostics are carried out by examination using binocular indirect ophthalmoscopy with a lens of 28 diopters. Recently, many digital diagnostic tools have been developed, but they are still not good enough to replace traditional ones. The pathogenesis of the disease is extremely complex and includes two phases, the first of which is vaso-obliterative and the second is proliferative. When a premature baby is born, the environment changes, and the child moves from the womb where it received oxygen under a lower partial pressure to an environment with a much higher partial pressure, which initially leads to the cessation of retinal blood vessel growth. As the child grows, so do the demands for oxygen, so there is a renewed and aggressive irregular proliferation of blood vessels in the retina, which occurs under the influence of IGF-1 and VEGF. There are many other pathogenetic mechanisms of this process, which are discussed in this graduation thesis. Knowing the pathogenetic processes helps us to understand, diagnose and treat the disease more easily, which leads to a reduced number of the worst complications of this disease, retinal detachment and blindness. |
