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Ocular Hypertension in Adults with a History of Prematurity
Joshua Robinson1, Albert Y Cheung2, Eric Nudleman3
1Emory Eye Center, Emory University Medical School, Atlanta, Georgia.
Insights
Patients born prematurely face a higher risk of ocular hypertension (OHT) and glaucoma, even without retinopathy of prematurity (ROP) treatment. Severe ROP and incisional surgery increase OHT incidence, necessitating lifelong monitoring.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Public Health
Background:
- Premature birth is a significant risk factor for long-term ocular complications.
- Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature infants.
- Ocular hypertension (OHT) and glaucoma are serious potential sequelae.
Purpose of the Study:
- To determine the incidence of ocular hypertension (OHT) in patients with a history of prematurity.
- To evaluate the impact of interventions for acute retinopathy of prematurity (ROP) on OHT development.
Main Methods:
- Retrospective case series of 407 eyes from 213 patients born prematurely (gestational age <32 weeks).
- Data collected included ROP stage, management interventions (laser, cryotherapy, vitrectomy), and OHT development.
- OHT defined as requiring glaucoma medication or surgery for elevated intraocular pressure.
Main Results:
- 38.1% of eyes developed OHT within 69 years of follow-up.
- Eyes requiring incisional retinal surgery for ROP had a significantly higher OHT incidence (58.5%) compared to those without treatment (23.2%).
- Higher ROP stages and aphakia were associated with increased OHT risk.
Conclusions:
- Premature infants are at increased lifelong risk for OHT and glaucoma, irrespective of ROP treatment.
- The severity of ROP and the need for surgical intervention are associated with a higher incidence of OHT.
- Enhanced lifelong monitoring is crucial for patients with a history of prematurity to manage potential adverse ocular outcomes.
Purpose:
To determine the ocular hypertension (OHT) incidence in patients with a history of prematurity and the effect of intervention for acute retinopathy of prematurity (ROP) in infancy on OHT incidence.
Design:
Retrospective case series at a single tertiary referral vitreoretinal practice.
Participants:
A total of 407 eyes of 213 patients were included, with ROP stage 0 to 5.
Methods:
A retrospective chart review was conducted of patients aged ≥15 years, seen from 1973 to 2013, with a history of premature birth (gestational age <32 weeks). Data were collected from patient charts, including gender, date of birth, gestational age at birth, birth weight, stage of ROP at presentation, management (including laser, cryotherapy, lens-sparing vitrectomy [LSV], or lensectomy-vitrectomy). Ocular hypertension (if present) data included age of onset, timing of glaucoma surgery (if performed), lens status, and last follow-up examination.
Main Outcome Measures:
Development of OHT, defined as eyes requiring a glaucoma medication for more than 6 consecutive months or surgical intervention for elevated intraocular pressure.
Results:
Of included eyes, 155 (38.1%) developed OHT within 69 years of follow-up. Subgroup analyses revealed an OHT incidence of 23.2% (36/155 eyes) in eyes without a history of any treatment for acute ROP (spontaneously regressed), 23.3% (10/43 eyes) in eyes that underwent ablative therapy alone, and 58.5% (76/130 eyes) in eyes requiring acute incisional retinal surgery (P < 0.01). Stage 4 eyes had a lower OHT incidence compared with stage 5 eyes (40.5% [17/42] vs. 66.7% [54/81], P < 0.01); however, among stage 4 and stage 5 eyes, phakic eyes at last follow-up had a decreased OHT incidence compared with aphakic eyes (27.8% [5/18] vs. 69.8% [60/86], P < 0.01).
Conclusions:
Patients with a history of extreme prematurity are at an increased risk of OHT and glaucoma, even if they did not receive acute ROP treatment. More severe acute ROP is associated with higher incidence of OHT, and this is associated with an increased incidence of incisional surgical intervention. Awareness of the increased lifelong risk of adverse ocular sequelae in patients with a history of prematurity will help guide appropriate monitoring.
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