Short-term incidence and management of glaucoma after successful surgery for stage 4 retinopathy of prematurity

Abstract

Purpose: The purpose of this study is to describe the short-term incidence, clinical features, and management of glaucoma in children after successful surgery for stage 4 retinopathy of prematurity (ROP). Methods: The retrospective study included all eyes undergoing successful surgery for stage 4 ROP with good outcomes at a tertiary eye care center between June 2014 and June 2016. Cases developing postoperative glaucoma underwent examination under anesthesia for measurement of intraocular pressures (IOP), corneal diameters, Retcam-assisted fundus imaging, and gonioscopy. Outcomes of glaucoma management were evaluated. Results: Hundred eyes of 70 babies underwent successful surgery for stage 4 ROP (with postoperative attached retina, and minimal sequelae) with minimum follow-up of 15 months. Six eyes (6%) developed postoperative glaucoma. Of these, four eyes had undergone lens-sparing vitrectomy and two were managed with lensectomy and vitrectomy (LV). Median time duration for development of glaucoma after primary vitreous surgery was 17.5 weeks. Two cases could be managed with topical IOP-lowering agents alone, whereas four required filtering surgeries (trabeculotomy with trabeculectomy and 0.04% mitomycin C [MMC] application). Average IOP decreased from 25 ± 2.36 to 12.2 ± 2.05 mmHg at 12 months from glaucoma diagnosis. Conclusion: Glaucoma is a potential adverse event following successful vitreous surgery for stage 4 ROP. A combined trabeculotomy–trabeculectomy along with MMC gives favorable outcome.

Vitrectomy Results for Stages 4 and 5 Retinopathy of Prematurity in Iraq

“…LSV has the advantage of better visual rehabilitation as it at least avoids aphakic amblyopia and aphakic glaucoma, 16 however successful retinal reattachment following LSV for ROP does not prevent the occurrence of late complications, like recurrent RD, lens opacification, in addition to secondary glaucoma. 22 The mechanism of secondary glaucoma might be explained by a number of factors, like is steroid response, which occur faster in comparison to other causes, 23 trabecular angle dysgenesis, 24 shallowing of the anterior chamber, 2 and choroidal body swelling from retinal photocoagulation. 25…”

Cataract Associated with ROP and Other Retinal Pathologies

“…In older cases with mental retardation and those who cannot cooperate for slit lamp YAG capsulotomy, PCCC and anterior vitrectomy can be done [12]. Glaucoma is a common complication associated with both premature babies and pediatric cataract surgery [40,49,50]. The difference in the anterior segment of these individuals increases the risk of glaucoma [33].…”