Retinopathy of prematurity (ROP) surgery: what it is and why it is needed
Retinopathy of prematurity (ROP) surgery is the umbrella term parents often use for the treatments that stop abnormal blood vessels damaging the retina of a baby born early. In the womb the retinal blood vessels grow outwards from the optic nerve and reach the edge of the retina close to full term. In a premature baby this growth is interrupted; the vessels that are missing leave part of the retina short of oxygen, and the eye may respond by growing fragile new vessels that leak, scar and can pull the retina off the back of the eye. Most babies with ROP never need treatment because the condition settles by itself. Treatment is for the minority in whom it reaches a threshold where sight is at risk.
This guide explains what the treatments are, how urgent they are, what the evidence says, who can realistically travel, what they cost in Turkey compared with the UK, US and Germany, and the questions to put to a hospital. It is written for parents; it does not replace the advice of your baby's own neonatal and eye teams. For the wider specialty see our eye treatments in Turkey hub.
How is ROP found, and when does it need treatment?
ROP is found by screening, not by symptoms. In the UK, babies born before 32 weeks or weighing under 1,501 g are examined by an ophthalmologist, starting at about four weeks of age, with repeat checks every one to two weeks until the retina is fully vascularised. Similar programmes run in other countries. The doctor dilates the pupils and looks at the retina with an indirect ophthalmoscope or a wide-field camera.
ROP is described by stage (1 to 5), by zone (how close to the optic nerve the disease lies) and by whether the vessels near the optic nerve are dilated and twisted, known as plus disease. Treatment is recommended for the high-risk forms, commonly called type 1 ROP: for instance disease in zone I, or stage 2 or 3 with plus disease. International trials showed that treating these eyes early, generally within 48 to 72 hours of the decision, improves outcomes compared with waiting. That timing is the first fact a family has to weigh against any thought of travel.
Laser, injection or vitrectomy: which ROP treatment is used?
The options differ by how advanced the disease is.
- Laser photocoagulation: the surgeon applies hundreds of tiny laser burns to the peripheral retina that has no blood supply. This removes the oxygen-starved tissue that drives the abnormal vessels. It has the longest track record and remains the standard in many units.
- Anti-VEGF injection: a medicine such as bevacizumab or ranibizumab is injected into the vitreous to block the growth signal. It is quick, is useful in very posterior disease or when the eye is hard to laser, but the retina is still incompletely vascularised afterwards, so longer follow-up is needed.
- Retinal surgery: if scarring has begun to pull the retina away (stage 4 or 5), a vitreoretinal surgeon may perform a vitrectomy or scleral buckle. The aim is to reattach the retina; results are less certain the later it is done. See vitreoretinal surgery for how this kind of operation works in general, and retina treatments for related conditions.
Older cryotherapy, which freezes the peripheral retina, is rarely used now. The choice between laser and injection is made by the treating ophthalmologist, who weighs the zone, the baby's general health and the available follow-up.
Does ROP treatment work? What does the evidence say?
Well-conducted trials, including the Early Treatment for ROP study, show that treating high-risk disease at the right time reduces blindness compared with waiting. Laser and anti-VEGF both control the disease in most treated eyes. Beyond that the evidence is more nuanced: the long-term effect of anti-VEGF drugs on general development is still being studied, laser can reduce the side vision of the eye, and children who had ROP carry a higher lifetime risk of short-sightedness, squint and amblyopia whether or not they were treated. Once the retina has detached, outcomes are much more variable. No honest hospital promises that a child will see normally.
Who can travel for ROP treatment, and who should not?
This is the most important question on this page. Active, high-risk ROP is a time-critical emergency in a baby who is usually still in a neonatal unit, often on oxygen support. Moving a fragile premature baby over borders is rarely safe or practical, and treatment should normally be given where the baby is, by the screening team. If you are told that treatment is due, ask that team first whether it can be done locally or at a regional centre.
Travel is more realistic in other situations: an older infant or child who is medically stable and needs a second opinion; a child with stage 4 or 5 disease where vitreoretinal surgery is being considered; or a child whose retina needs review after earlier treatment. In those cases a hospital can review reports and images before you commit. Ongoing issues such as squint are also treated separately; see strabismus surgery and paediatric squint care.
What happens during ROP treatment, step by step?
Laser and injection treatment is usually done in the neonatal unit or an operating theatre, with the baby monitored throughout. Pupils are dilated and an eyelid holder keeps the eye open. Laser is performed with a laser attached to an indirect ophthalmoscope; the baby usually has local anaesthetic drops and sedation or a light general anaesthetic with breathing support, depending on the unit. The session can take 20 to 60 minutes. An injection takes a few minutes with antiseptic cleaning and a fine needle. Retinal surgery for stage 4 or 5 is a longer operation under general anaesthesia, from one to several hours.
The baby is checked within days, then weekly, to see whether the vessels are regressing and whether re-treatment is needed.
Retinopathy of prematurity (ROP) surgery cost in Turkey compared with the UK, US and Germany
The figures are approximate ranges per eye for treatment alone, not hospital quotes. They exclude neonatal intensive care, which can add substantially, and international transport. In the UK, treatment of babies is provided within the NHS, so private prices mainly matter for older children and second opinions. Each hospital confirms its own price in writing.
| Country | Approximate cost range per eye |
|---|---|
| Turkey | €1,200 – €6,000 |
| United Kingdom | €3,500 – €10,000 |
| United States | €6,000 – €25,000 |
| Germany | €3,000 – €9,000 |
What changes the price: laser or injection versus vitrectomy, one eye or both, the anaesthesia and monitoring needed, any hospital stay, and follow-up examinations. A package should state what is covered if re-treatment is required.
Laser, anti-VEGF injection and surgery compared
| Treatment | Suited to | Typical limits |
|---|---|---|
| Laser photocoagulation | Type 1 ROP in zone II and many other eyes | Permanent loss of peripheral retina; more myopia in some children |
| Anti-VEGF injection | Very posterior disease, hazy eyes that are hard to laser | Needs long follow-up; recurrence can occur after weeks or months |
| Vitrectomy or buckle | Partial or total retinal detachment (stages 4 and 5) | Variable visual results; later surgery means less chance of useful sight |
Recovery, aftercare and follow-up
After laser or injection the eyes may look red or swollen and the baby may be sleepy; antibiotic or steroid drops are used for a few days. After an injection the team watches for infection and a rise in eye pressure. Re-examination happens within the first week and then every week or two until the retinal vessels have grown to the edge of the retina and the disease has clearly regressed. After vitrectomy, drops are used for several weeks and the baby may need positioning advice, with checks for pressure and re-detachment.
Follow-up does not end there. Children who have had ROP need regular eye checks for glasses, squint and lazy eye throughout childhood, and later retina checks because of the higher risk of retinal problems. If you travel for an assessment or operation, plan a stay long enough for the first checks, and make sure a named doctor at home will take over follow-up with the written reports.
Risks and complications of ROP treatment
Treatment carries risks, and untreated high-risk ROP carries larger ones. Laser and injection can cause bleeding in the eye, cataract, raised pressure, infection (endophthalmitis) and swelling of the eyelids; any anaesthetic in a premature baby has its own risks, which is why it is done by paediatric anaesthetists. Laser can reduce peripheral vision. With injections, reactivation of ROP can occur late. Retinal surgery adds the risks of re-detachment, scarring and further operations. The Royal College of Ophthalmologists and the Royal College of Paediatrics and Child Health publish UK guidance on screening and treatment that is a useful benchmark for any unit.
How to choose a hospital and red flags
Look for a unit that screens and treats premature babies regularly, with a paediatric ophthalmologist or vitreoretinal surgeon, a paediatric anaesthetist and a neonatal intensive care unit on site. A hospital should ask for your child's records, gestational age, birth weight, screening results and any images before offering a plan. Red flags include a firm price or promise of cure before records are reviewed, pressure to travel at once with an unstable baby, no plan for follow-up at home, and claims of guaranteed vision. Read how our process works and request a review through the free quote page.
Questions to ask the hospital
- How many babies with ROP does the team treat each year, and with which methods?
- Is a neonatal intensive care unit and a paediatric anaesthetist on site?
- What is the plan if the disease returns or the retina detaches?
- What does the price include, and what if re-treatment is needed?
- Who will do follow-up at home and will you send full reports and images?
Hospitals with Eye Surgery in Turkey
Frequently asked questions
ROP is an eye condition of premature babies in which the retinal blood vessels have not finished growing. Abnormal vessels can develop, leak and scar, and in severe cases pull the retina away. Most cases resolve without treatment.
Treatment is recommended for high-risk (type 1) disease, such as zone I ROP or stage 2 or 3 with plus disease. Studies show treating within about 48 to 72 hours of that decision improves the chance of protecting sight.
Laser and anti-VEGF injections control the disease in most treated eyes, and timely treatment reduces blindness compared with waiting. Vision afterwards varies, and children often need glasses and follow-up for squint and lazy eye.
Approximate ranges are €1,200 to €6,000 per eye in Turkey against about €3,500 to €10,000 in the UK, excluding neonatal intensive care. Price depends on laser, injection or surgery, and a hospital confirms it in writing.
Neither is universally preferable. Laser has the longest track record, while injections suit very posterior disease or eyes that are hard to laser. The treating ophthalmologist chooses based on zone, stage and the baby's health.
Rarely. Active ROP is time-critical and the baby is usually unwell and on a neonatal unit, so treatment is normally given locally. Travel is more realistic for older, stable children needing a second opinion or retinal surgery.
Babies receive anaesthetic drops with sedation or a general anaesthetic, plus pain relief, and are monitored throughout. Afterwards the eyes may look red or swollen for a few days, which the team manages with drops.
The eyes settle within days to a couple of weeks, but monitoring continues every one to two weeks until the retinal vessels have fully grown. Long-term eye checks are needed throughout childhood.
Yes, particularly after anti-VEGF injections, where the disease can reactivate weeks or months later. That is why scheduled follow-up examinations matter, and why the plan for re-treatment should be agreed in advance.
A records review can be done remotely first. For an in-person assessment or retinal surgery, plan a stay long enough for the first checks, often about a week, set by the surgeon according to the operation.