Management outcomes of secondary glaucoma due to retinopathy of prematurity: A 19-year prospective study at a tertiary eye care Institute. The Indian Twin cities ROP Screening (ITCROPS) database report number 8.

Sirisha Senthil,Ashik Mohamed,Padmaja Kumari Rani,Pasyanthi Balijepalli,Subhadra Jalali,Chandrasekar Garudadri,Sameera Nayak,Anil K Mandal,Demetrios G Vavvas

doi:10.1371/journal.pone.0238633

Abstract

To report the clinical presentation and management outcomes of glaucoma in the "Indian Twin cities retinopathy of prematurity (ROP) Screening database." All children with diagnosis of ROP and glaucoma between 1997 and 2016 from a prospective database were included. Glaucoma was classified as open when anterior chamber (AC) was deep, closed when AC was shallow or flat and neovascular when there was extensive iris neovascularization. ROP was classified based on International classification of ROP. The prevalence of secondary glaucoma in our cohort was 1.36% (82 eyes of 6000 children). Eighty-two eyes of 54 children with secondary glaucoma due to ROP where included in this study. The distribution of glaucoma among the ROP stages included, stage V (58.5%), stage 1V (24.3%), stage III (2.4%) and stage II (1.2%) eyes. Median (interquartile range) duration from birth to glaucoma diagnosis was 7.8 (4.2, 24.9) months. Type of glaucoma was angle closure in 39 (47.6%), open angle in 35 (42.7%) and neovascular in 8 (9.8%) eyes. Retinal interventions included vitreoretinal surgery in 59 (72%), retinal laser in 14 (17%) and intravitreal bevacizumab injection in 19 (23.1%) eyes. The mean (±standard deviation) IOP at presentation was 22.6 ±11.8 mm Hg. Glaucoma was managed medically in 66 (76%) and surgically in 16 (19.5%) eyes. The mean follow up for the entire cohort was 1.14±2.24 years. At final visit, 37% eyes with ROP and glaucoma had ambulatory vision with mean IOP of 16.0±8.1 mm Hg and 56 eyes (68.2%) needed glaucoma medications. In this large ROP cohort, 1.36% eyes developed secondary glaucoma. Majority of them had stage V or IV ROP and 1/5 of them needed glaucoma surgery. Around 1/3rd of the ROP eyes with glaucoma had ambulatory vision.

Highlights

Retinopathy of prematurity (ROP) is a disease of developing retinal vasculature in premature infants
Eighty-two eyes of 54 children with secondary glaucoma due to ROP where included in this study
Various retinal and non-retinal complications have been reported in children with ROP and these complications increase with increasing severity of ROP [3]

Summary

Introduction

Retinopathy of prematurity (ROP) is a disease of developing retinal vasculature in premature infants. It is a disease of modern era where application of technology to save the lives of these premature children is associated with sight threatening consequences. Glaucoma is an important sight threatening complication among these children with severe stages of ROP, with nearly 1/3 of all eyes of unoperated stage V ROP developing glaucoma [4, 5]. Various mechanisms for the development of glaucoma in eyes with ROP have been proposed. Laser for ROP can rarely be associated with recurrent hyphema or elevated IOP secondary to angle closure, which may resolve without long-term sequelae or may need intervention [11, 12]

Methods

Results

Conclusion