ICD-10: H35.17

Retrolental fibroplasia (RLF), now more commonly referred to as retinopathy of prematurity (ROP), is a significant condition primarily affecting premature infants. The clinical presentation, signs, symptoms, and patient characteristics associated with this condition are crucial for early diagnosis and management. Below is a detailed overview of these aspects.

Clinical Presentation

Retrolental fibroplasia typically occurs in infants born before 28 weeks of gestation or those with a birth weight of less than 1500 grams. The condition arises due to abnormal blood vessel growth in the retina, which can lead to scarring and retinal detachment. The clinical presentation can vary significantly based on the severity of the disease.

Signs and Symptoms

1. Visual Impairment: Many infants with RLF may not show immediate symptoms, but as they grow, they may exhibit signs of visual impairment. This can include difficulty tracking objects or a lack of response to visual stimuli.

2. Strabismus: Misalignment of the eyes (strabismus) can occur, which may be a sign of underlying visual issues.

3. Nystagmus: In some cases, involuntary eye movements (nystagmus) may be observed, indicating potential retinal damage.

4. Retinal Findings: Upon examination, ophthalmologists may observe specific retinal changes, including:
   - Vascular Abnormalities: These include dilated and tortuous blood vessels.
   - Fibrovascular Membranes: The presence of abnormal membranes behind the lens can be noted.
   - Retinal Detachment: In severe cases, the retina may become detached, leading to significant vision loss.

5. Other Associated Conditions: Infants with RLF may also have other complications related to prematurity, such as bronchopulmonary dysplasia or intraventricular hemorrhage, which can complicate their overall health status.

Patient Characteristics

Demographics

• Age: RLF primarily affects premature infants, particularly those born before 28 weeks of gestation.
• Birth Weight: Infants with a birth weight of less than 1500 grams are at a higher risk for developing RLF.
• Gestational Age: The risk increases with decreasing gestational age, with the highest incidence in those born at 24-28 weeks.

Risk Factors

• Oxygen Therapy: High levels of supplemental oxygen, often required for premature infants, have been linked to the development of RLF.
• Infection: The presence of infections, such as sepsis, can exacerbate the risk of developing retinal issues.
• Nutritional Status: Poor nutritional status and other comorbidities associated with prematurity can influence the severity of RLF.

Screening and Diagnosis

Early screening for RLF is critical, typically starting at 4-6 weeks of age for high-risk infants. The screening involves a thorough eye examination by a pediatric ophthalmologist, who will assess the retina for any signs of abnormal blood vessel growth or other complications.

Conclusion

Retrolental fibroplasia (H35.17) is a serious condition that primarily affects premature infants, leading to potential visual impairment and other complications. Understanding the clinical presentation, signs, symptoms, and patient characteristics is essential for timely diagnosis and intervention. Regular screening and monitoring of at-risk infants can significantly improve outcomes and help mitigate the long-term effects of this condition. Early detection and appropriate management are key to preserving vision and enhancing the quality of life for affected individuals.

Retrolental fibroplasia (RLF), classified under the ICD-10-CM code H35.17, is a condition primarily affecting premature infants, characterized by abnormal blood vessel growth in the retina. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some of the key alternative names and related terms associated with retrolental fibroplasia.

Alternative Names for Retrolental Fibroplasia

1. Retinopathy of Prematurity (ROP): While ROP is a broader term that encompasses various stages of retinal damage in premature infants, retrolental fibroplasia is often considered a specific manifestation of ROP, particularly in its more severe forms[1][2].

2. Fibroplasia Retrolentalis: This is the Latin term for retrolental fibroplasia and is sometimes used in medical literature and discussions[1].

3. Retrolental Fibrosis: This term emphasizes the fibrous tissue formation behind the lens, which is a hallmark of the condition[1].

4. Retinal Fibroplasia: This term may be used interchangeably in some contexts, although it is less specific than retrolental fibroplasia[1].

Related Terms

1. Premature Retinopathy: This term refers to the general condition affecting premature infants, which includes retrolental fibroplasia as a potential outcome[1].

2. Vascular Retinopathy: This broader term encompasses various retinal conditions characterized by abnormal blood vessel growth, including retrolental fibroplasia and other forms of retinopathy[1].

3. Ocular Complications of Prematurity: This term refers to a range of eye-related issues that can arise in premature infants, including retrolental fibroplasia and retinopathy of prematurity[1].

4. Neovascularization: This term describes the process of new blood vessel formation, which is a critical aspect of retrolental fibroplasia and other retinal diseases[1].

5. Retinal Detachment: Although not synonymous, retinal detachment can occur as a complication of retrolental fibroplasia, making it a related term in discussions of the condition's potential outcomes[1].

Conclusion

Understanding the alternative names and related terms for retrolental fibroplasia is essential for accurate communication in clinical settings. These terms not only facilitate better documentation but also enhance the understanding of the condition's implications for premature infants. If you need further information on the management or treatment of retrolental fibroplasia, feel free to ask!

Retrolental fibroplasia (RLF), now more commonly referred to as retinopathy of prematurity (ROP), is a condition that affects premature infants, leading to abnormal blood vessel growth in the retina. The ICD-10-CM code for this condition is H35.17, which specifically denotes "Other retinal disorders" related to retrolental fibroplasia.

Diagnostic Criteria for Retrolental Fibroplasia (H35.17)

The diagnosis of retrolental fibroplasia involves several criteria and assessments, primarily focusing on the clinical evaluation of the infant's eyes and the presence of specific risk factors. Here are the key components:

1. Clinical Examination

• Fundoscopic Examination: A thorough examination of the retina using an ophthalmoscope is essential. This examination helps identify the characteristic findings of ROP, such as:
  • Abnormal blood vessel growth (neovascularization).
  • Retinal detachment or scarring.
  • Presence of a fibrovascular membrane behind the lens.

2. Gestational Age and Birth Weight

• Prematurity: ROP primarily affects infants born before 32 weeks of gestation. The lower the gestational age, the higher the risk of developing ROP.
• Low Birth Weight: Infants with a birth weight of less than 1500 grams (approximately 3.3 pounds) are at increased risk.

3. Oxygen Therapy

• Oxygen Exposure: Infants who receive supplemental oxygen therapy, especially in the neonatal intensive care unit (NICU), are at risk. Monitoring oxygen levels and avoiding fluctuations is crucial.

4. Screening Guidelines

• Regular Screening: The American Academy of Pediatrics (AAP) and the American Academy of Ophthalmology (AAO) recommend regular screening for ROP in high-risk infants. This typically begins at 4-6 weeks of postnatal age or at 28-30 weeks of gestational age, whichever comes first.

5. Staging of ROP

• ROP Staging: The severity of ROP is classified into five stages, ranging from mild (Stage 1) to severe (Stage 5), with higher stages indicating more severe disease and a greater risk of vision impairment. The staging is based on the extent of retinal involvement and the presence of abnormal blood vessels.

Conclusion

The diagnosis of retrolental fibroplasia (H35.17) is a multifaceted process that requires careful clinical evaluation, consideration of risk factors such as gestational age and birth weight, and adherence to established screening protocols. Early detection and intervention are critical in managing ROP to prevent vision loss in affected infants. Regular follow-up and monitoring are essential for those diagnosed with this condition to ensure optimal outcomes.

Retrolental fibroplasia (RLF), also known as retinopathy of prematurity (ROP), is a condition primarily affecting premature infants, characterized by abnormal blood vessel growth in the retina. The ICD-10 code H35.17 specifically refers to "Retrolental fibroplasia," which is crucial for accurate diagnosis and treatment planning. Here’s an overview of standard treatment approaches for this condition.

Understanding Retrolental Fibroplasia

Retrolental fibroplasia occurs when the normal development of retinal blood vessels is disrupted, often due to factors such as oxygen therapy in premature infants. This can lead to scarring and retinal detachment, potentially resulting in vision impairment or blindness if not treated promptly.

Standard Treatment Approaches

1. Monitoring and Screening

• Regular Eye Examinations: Infants at risk, particularly those born before 28 weeks of gestation or with a birth weight less than 1500 grams, should undergo regular eye examinations starting at 4-6 weeks of age. The frequency of these exams may increase based on the infant's condition and the severity of ROP observed during screenings[1].

2. Laser Therapy

• Laser Photocoagulation: This is the most common treatment for severe ROP. It involves using a laser to destroy the peripheral retina, which helps to reduce the stimulus for abnormal blood vessel growth. This procedure is typically performed in an outpatient setting and can significantly reduce the risk of vision loss[2].

3. Cryotherapy

• Cryotherapy: In some cases, cryotherapy may be used as an alternative to laser treatment. This involves freezing the peripheral retina to halt the progression of ROP. However, laser therapy has largely replaced cryotherapy due to its effectiveness and lower complication rates[3].

4. Anti-VEGF Therapy

• Intravitreal Injections: Anti-vascular endothelial growth factor (anti-VEGF) agents, such as bevacizumab, can be injected into the eye to inhibit the growth of abnormal blood vessels. This treatment is particularly useful in cases of aggressive ROP and can be used in conjunction with laser therapy[4].

5. Surgical Interventions

• Surgery for Retinal Detachment: In cases where ROP has progressed to retinal detachment, surgical intervention may be necessary. Procedures such as vitrectomy can be performed to repair the retina and restore vision, although outcomes can vary significantly depending on the extent of the detachment[5].

6. Supportive Care

• Oxygen Management: Careful management of oxygen levels is crucial in preventing ROP. Maintaining appropriate oxygen saturation levels can help minimize the risk of developing this condition in at-risk infants[6].

Conclusion

The management of retrolental fibroplasia involves a combination of monitoring, laser therapy, potential use of anti-VEGF agents, and surgical interventions when necessary. Early detection and treatment are vital to improving outcomes for affected infants. Continuous research and advancements in treatment protocols are essential to enhance the care provided to this vulnerable population. Regular follow-ups and supportive care play a critical role in the overall management of RLF, ensuring that infants receive the best possible chance for healthy vision development.

For further information or specific case management, consulting with a pediatric ophthalmologist is recommended.

Retrolental fibroplasia (RLF), also known as retinopathy of prematurity (ROP), is a condition primarily affecting premature infants, characterized by abnormal blood vessel development in the retina. The ICD-10 code for this condition is H35.17, which falls under the broader category of "Other retinal disorders."

Clinical Description of Retrolental Fibroplasia

Pathophysiology

Retrolental fibroplasia occurs when the normal development of retinal blood vessels is disrupted, typically in infants born before 32 weeks of gestation or with a birth weight of less than 1500 grams. In these infants, the retina may not receive adequate oxygen, leading to the formation of abnormal blood vessels. These vessels can grow into the vitreous gel of the eye, potentially causing scarring and retinal detachment, which can result in vision impairment or blindness if not treated promptly[1].

Symptoms

The symptoms of retrolental fibroplasia can vary, but many affected infants may not show any immediate signs. However, as the condition progresses, potential symptoms may include:
- Strabismus: Misalignment of the eyes.
- Nystagmus: Involuntary eye movements.
- Visual impairment: Difficulty seeing or recognizing objects.
- Amblyopia: Reduced vision in one or both eyes due to abnormal visual development.

Diagnosis

Diagnosis of retrolental fibroplasia typically involves a comprehensive eye examination, often using indirect ophthalmoscopy. The examination assesses the retina for signs of abnormal blood vessel growth and scarring. Screening guidelines recommend that all infants born before 30 weeks of gestation or with a birth weight of less than 1500 grams undergo regular eye examinations starting at 4-6 weeks of age[2].

Treatment

Treatment options for retrolental fibroplasia depend on the severity of the condition. They may include:
- Laser therapy: To destroy abnormal blood vessels and prevent further complications.
- Cryotherapy: In some cases, freezing treatment may be used to halt the progression of the disease.
- Surgery: For severe cases involving retinal detachment, surgical intervention may be necessary to reattach the retina and restore vision.

Prognosis

The prognosis for infants with retrolental fibroplasia varies widely. Early detection and treatment can significantly improve outcomes, but some infants may still experience long-term visual impairment or blindness. Regular follow-up care is essential to monitor vision development and address any complications that may arise[3].

Conclusion

Retrolental fibroplasia (ICD-10 code H35.17) is a serious condition that primarily affects premature infants, necessitating early diagnosis and intervention to prevent severe visual impairment. Understanding the clinical aspects, including symptoms, diagnosis, treatment options, and prognosis, is crucial for healthcare providers involved in the care of at-risk infants. Regular screening and timely treatment can lead to better outcomes and improved quality of life for affected individuals.

References

1. Clinical Policy: Extended Ophthalmoscopy.
2. Clinical Policy: Fluorescein Angiography.
3. Billing and Coding: Ophthalmology: Posterior Segment.