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Conjunctival impression cytology in the preterm infant and it's relation to outcome
A P Hughes1, N J Shaw, P Southall
1Department of Ophthalmology, Liverpool Women's Hospital, UK.
Insights
Conjunctival impression cytology (CIC) is a feasible method for assessing vitamin A (retinol) status in preterm infants. Abnormal CIC findings in premature infants are linked to retinopathy requiring treatment.
Area of Science:
- Neonatology
- Ophthalmology
- Nutritional Science
Background:
- Preterm infants often have vitamin A (retinol) deficiency, potentially contributing to chronic lung disease.
- Conjunctival impression cytology (CIC) is an established method for evaluating retinol status in adults.
Purpose of the Study:
- To evaluate the feasibility of performing CIC in preterm infants.
- To determine the clinical significance of abnormal CIC findings in this population.
Main Methods:
- CIC samples were collected during routine retinopathy screening in 90 preterm infants.
- Specimens were classified as inadequate, normal, borderline normal, or abnormal.
- Inter-observer reliability and intra-observer agreement were assessed.
Main Results:
- A high yield (82%) of adequate CIC specimens was achieved.
- Abnormal CIC findings were observed in 18% of adequate samples.
- Infants with abnormal CIC had lower birth weights and a higher incidence of retinopathy requiring treatment (32% vs 3%).
Conclusions:
- Conjunctival impression cytology is a simple, reproducible, and feasible technique for preterm infants.
- Abnormal CIC findings in preterm infants are associated with retinopathy of prematurity that necessitates treatment.
Unlabelled:
The preterm infant is deficient in vitamin A (retinol) and this has been implicated in the pathogenesis of chronic lung disease of prematurity. Conjunctival impression cytology (CIC) has been used in adults to assess retinol status. We aimed to assess the feasibility of performing CIC in the preterm infant and to determine the significance of abnormal CIC findings. CIC samples were collected during routine retinopathy screening, and classified as inadequate, normal, borderline normal or abnormal. Ninety preterm infants were studied. Seventy-four (82%) CIC specimens produced a positive yield, whereas 16 (18%) were inadequate. Of the 74 adequate samples, 61 (82%) were normal or borderline normal and 13 (18%) abnormal. Seventy-three CIC specimens were assessed by a second histopathologist with complete agreement on 64 (88%) samples and disagreement on 9 (12%) samples. Ten sets of conjunctival impressions, taken from both eyes, gave identical results in all adequate samples. Birth weight was significantly lower in this abnormal group. Four infants (32%) in the abnormal group required treatment for retinopathy compared to two (3%) in the normal/borderline normal group, (P < 0.01).
Conclusion:
Conjunctival impression cytology is simple and reproducible technique which maybe easily applied to the preterm infant. Abnormal CIC is associated with retinopathy of prematurity requiring treatment.