Topical application of Ringer's lactate for Stage 1 Retinopathy of Prematurity: A potential treatment hypothesis

Retinopathy of Prematurity (ROP) is a disorder affecting the developing retinal vasculature in preterm infants and is one of the major preventable causes of childhood blindness worldwide. The pathogenesis of ROP is characterized by two distinct phases: Phase 1 occurs when preterm infants are exposed to relative hyperoxia compared to in-utero conditions, either from atmospheric oxygen or supplemental therapy. This exposure causes vaso-obliteration and disrupts peripheral retinal vascularization. In Phase 2, the resulting peripheral avascular retina becomes hypoxic, triggering the release of pro-angiogenic factors like VEGF. This leads to proliferative retinopathy, potentially causing complications such as retinal detachment and permanent blindness in affected neonates. Current management strategies in ROP include intravitreal anti-VEGF injections and laser photocoagulation. Lactate is a well-known pro-angiogenic molecule. We hypothesize that topical administration of lactate in the form of Ringer's lactate solution in the eye in Phase 1 of ROP would allow normal retinal vascularisation, potentially preventing the progression of ROP to Phase 2. This approach warrants investigation as a potential therapy to reduce the incidence of phase 2 ROP and its complications.