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Case Report: Glaucoma in an Infant With Retinopathy of Prematurity
Tamara Lee Lenis1, Nahomy Ledesma Vicioso1, Varun Reddy1
1Department of Ophthalmology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States.
Insights
Retinopathy of prematurity (ROP) can lead to childhood blindness. A case report highlights glaucoma development after ROP laser treatment, emphasizing the need for ongoing screening.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Surgery
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness due to incomplete retinal vascularization in preterm infants.
- Glaucoma is an ocular comorbidity in some ROP patients, potentially linked to anterior chamber development, ROP, or its treatments.
- Previous reports noted narrow-angle glaucoma post-ROP laser treatment.
Observation:
- A case report details a preterm infant (24 weeks 5 days gestation) with treatment-requiring ROP who underwent laser photocoagulation.
- The infant subsequently developed severe intraocular pressure elevation and shallow anterior chambers, notably without pupillary block.
- Bilateral ab externo trabeculotomy was performed, leading to normalization of intraocular pressure.
Findings:
- This case presents elevated intraocular pressure and anterior chamber narrowing post-laser therapy for ROP, distinct from prior reports as it lacked pupillary block or synechiae.
- The etiology appears multifactorial, potentially involving incomplete angle development, ischemia, and the laser treatment itself.
- The patient remained stable at 51 weeks postmenstrual age following the surgical intervention.
Implications:
- The findings underscore the importance of comprehensive glaucoma screening for retinopathy of prematurity patients.
- Screening should be considered both short-term and long-term due to potential multifactorial glaucoma development.
- This case expands understanding of glaucoma presentation in the context of ROP treatment.
Abstract:
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness that occurs due to incomplete development of retinal blood vessels in preterm infants. Glaucoma is an ocular comorbidity in some patients with ROP, and it may be associated with immature anterior chamber development, ROP itself, or the treatment for ROP. There have been a few reports of narrow-angle glaucoma after laser treatment for ROP. In this case report, we describe the course of a female infant born at 24 weeks and 5 days of gestational age with treatment-requiring ROP treated with laser photocoagulation who subsequently developed very elevated intraocular pressure and shallow anterior chambers without pupillary block. The patient required bilateral ab externo trabeculotomy for elevated intraocular pressure, which normalized after the procedure. The patient has remained stable at the last follow-up at 51 weeks postmenstrual age. Differing from previous glaucoma presentations in this setting, we illustrate a case of elevated intraocular pressure and anterior chamber narrowing after laser therapy without pupillary block or synechiae. The possible multifactorial etiology of glaucoma in this patient, including incomplete angle development, ischemia, and laser treatment, highlight the need for glaucoma screening in patients with ROP, both in the short and long term.
