Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Severe ROP has a short treatment window
Aggressive ROP and posterior disease can progress rapidly to retinal detachment. Infants usually have no external eye signs that allow families or ward staff to recognise this progression.
Action: Discuss treatment-requiring or referral-warranted findings promptly with the network treating ophthalmologist. Aggressive ROP or zone I stage 3 with plus disease needs treatment as soon as possible and within 48 hours; organise transfer and neonatal support accordingly.
Synopsis
Apply current UK ROP screening eligibility and timing, recognise treatment-requiring retinal disease and maintain safe surveillance through transfer, treatment and discharge.
Screen all infants born before 31 weeks or with birthweight below 1501 g.
The October 2024 revision also says to consider screening infants born at 31+0 to 31+6 weeks.
Screening timing depends on both gestational and postnatal age.
Key red flags
A screening appointment is overdue, unrecorded or lost during neonatal transfer.
Investigation priorities
01
Scheduled dilated retinal examinationFirst step
Detect and classify ROP at the appropriate developmental time.
Management branches
First examinationCalculate and secure the screening date
A preterm or low-birthweight infant meets screening criteria or needs consideration under the 2024 extension.
Record birth gestation and weight, applying the less-than-31-week or less-than-1501-g criteria and considering the 31-week group.
Use the appropriate earlier-versus-later rule for the two gestational groups to calculate the first examination window.
Key medicines
Ranibizumab — Lucentis 10 mg/mL vial for neonatal ROPSpecialist neonatal dose: 0.2 mg in 0.02 mL intravitreally per treated eye. Up to three injections per eye may be given within six months if disease remains active, at least four weeks apart.
Aflibercept — Eylea 40 mg/mL pre-filled syringeSpecialist neonatal dose: 0.4 mg in 0.01 mL intravitreally per treated eye. Up to two injections per eye may be given within six months for disease activity, at least four weeks apart.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.
RCOphth: treating retinopathy of prematurity in the UK, executive summaryOfficial current-hosted copy of the March 2022 recommendations: treatment thresholds, 48- and 48–72-hour priorities, laser and anti-VEGF selection, and post-treatment review through at least 24 weeks. Product licensing and doses are checked against current SmPCs.
Lucentis 10 mg/mL: UK SmPCCurrent neonatal indication, 0.2-mg dose, repeat limits, delivery equipment and precautions.