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Cataract in retinopathy of prematurity - A review
Sudarshan Khokhar1, Abhidnya Surve2, Saurabh Verma2
1Cataract and Refractive Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
Cataracts in preterm infants with retinopathy of prematurity (ROP) complicate visual screening and treatment. This review details the causes, pathophysiology, and management strategies for these challenging cases, emphasizing timely intervention to prevent blindness.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Surgery
Background:
- Retinopathy of prematurity (ROP) poses a significant risk of blindness in preterm infants.
- The co-occurrence of cataracts with ROP complicates visual assessment, treatment, and follow-up.
- Systemic factors and ROP-related complications contribute to cataract development in preterm neonates.
Purpose of the Study:
- To review and synthesize current knowledge on cataracts in preterm infants with ROP.
- To elucidate the varied causes, pathophysiology, and types of cataracts associated with ROP.
- To highlight the challenges and critical management aspects of coexisting cataract and ROP.
Main Methods:
- Systematic review of studies focusing on preterm infants (<6 months) with ROP and cataracts.
- Evaluation of literature concerning cataract etiology, ROP association, and management strategies.
- Analysis of anatomical, surgical, and rehabilitative challenges.
Main Results:
- Cataracts in ROP cases stem from diverse causes, including systemic factors and ROP sequelae.
- Management requires careful consideration of surgical timing, intraoperative complexities, and postoperative care.
- Addressing anatomical differences, pupillary issues, and fundus visualization is crucial.
Conclusions:
- Effective management of cataracts in ROP necessitates a multidisciplinary approach.
- Timely surgical intervention and comprehensive follow-up are vital to optimize visual outcomes.
- Further research into specific management protocols for these complex cases is warranted.
Abstract:
Preterm babies with retinopathy of prematurity (ROP) can become blind if they do not receive appropriate timely intervention. The presence of cataract in these individuals in addition to visual deprivation amblyopia, also delays proper screening, adequate treatment, and makes follow-up assessment difficult. Anatomical differences in these infants and amblyopia management, especially in unilateral cataract, are other important concerns, and hence, management of these cases with cataract and ROP is challenging. In this review, studies where ROP cases were associated with cataract, were evaluated with a focus on preterm individuals less than 6 months age. Preterm babies are at increased risk of developing cataract because of systemic factors. In addition, those with ROP may have cataract associated with retinal detachment or treatment received. The type of cataract, risk factors, and pathophysiology associated with each cause varies. This review highlights these different aspects of cataract in ROP including causes, pathophysiology, types of cataracts, and management. The management of these cases is critical in terms of the timing of cataract surgery and the challenges associated with surgery and posterior segment management for ROP. Anatomical differences, preoperative retina status, pupillary dilatation, neovascularization of iris in aggressive posterior ROP, fundus examination, amblyopia, and follow-up are various important aspects in the management of the same. The preoperative workup, intraoperative challenges, postoperative care, and rehabilitation in these individuals are discussed.
