ROP: Vasculogenesis

10 Retinopathy of Prematurity: A Text and Atlas

NORMAL RETINAL
VASCULAR DEVELOPMENT
The immature retina has two blood supplies,
the outer choroidal vessels and the inner
retinal vessels. At a gestational age of 6 weeks
(5 mm stage), the hyaloid artery, a major
branch of the primitive dorsal ophthalmic
artery enters the globe and grows forward to
the posterior pole of the lens (Fig. 3.1). Upto
16 weeks of gestation choroidal vessels alone
nourish both outer and inner retina,
practically inner retina remains avascular.
About 16 weeks of gestational age the first
blood supply to inner retina appears in the
form of mesenchymal Spindle cells arising
from the adventitia of the hyaloid artery.
Spindle cells migrate in the inner retina from
the optic disc and reaches ora serrata.
23
The peripherally advancing spindle cells
are in the form of a circumferential apron,
which leaves behind solid cords that canalize
and metamorphose into mature vessels. The
rate of growth of the advancing spindle cells
is 0.1 mm/day and reaches normal ora serrata
by the 7th or 8th month and then temporal
ora serrata by the 9th month of gestational
age or at birth (Figs 3.2A to C).
24,25
This is
because temporal ora serrata is at a greater
distance from disc than nasal ora serrata.
Fig. 3.1: Normal vasculogenesis
ROP: Vasculogenesis 11
Figs 3.2A to C: A. Immature temporal retina 34 weeks gestational age; B. Immature temporal
retina 38 weeks gestational age; C. Mature temporal retina 40 weeks gestational age