Systemic adverse events after screening of retinopathy of prematurity with mydriatic

Abstract

Purpose To evaluate systemic adverse events after screening for retinopathy of prematurity (ROP) performed with mydriatic. Methods This was a retrospective case series study. Medical records of consecutive patients who underwent screening for ROP with 0.5% phenylephrine and 0.5% tropicamide eyedrops were retrospectively reviewed. The score of abdominal distention (0–5), volume of milk sucked and volume of stool, along with systemic details (pulse and respiration rates, blood pressure and number of periods of apnea) were collected at 1 week and 1 day before ROP examination, and at 1 day after examination. Results were compared between the days before and after examination. Correlation between body weight at the time of examination and the score of abdominal distention was examined. The numbers of infants with abdominal and/or systemic adverse events were compared between pre- and post-examination periods. Results Eighty-six infants met the inclusion criteria. The score of abdominal distention increased from 2.0 at 1 day before examination to 2.3 at 1 day after examination (p = 0.005), and the number of infants who had worsened abdominal distension increased after examination (p = 0.01). Infants with lower body weight had a higher score of abdominal distention (p < 0.0001, r = −0.57). The number of infants with reduced milk consumption increased after examination (p = 0.0001), as did the number of infants with decreased pulse rate (p = 0.0008). Conclusions Screening for ROP with mydriatic may have adverse effects on systemic conditions. Infants should be carefully monitored after ROP screening with mydriatic.

Low dose or very low dose phenylephrine and cyclopentolate microdrops for retinopathy of prematurity eye examinations (The Little Eye Drop Study): a randomised controlled non-inferiority trial

“…Our study, alongside other published literature, suggests that the use of microdrops produces adequate pupil dilation for a successful ROPEE 7 8 12. A surprising finding was that ophthalmologists were able to perform a ROPEE with pupil dilation as low as 3 mm, although there were 20% missing pupil dilation data, so results should be interpreted with caution.…”

“…Mydriatic eye drops are associated with adverse effects and therefore efforts to reduce drug exposure during ROPEE are ongoing. In addition to cardiovascular and respiratory effects, case reports and studies have documented NEC, seizures, anticholinergic syndrome, periorbital pallor and renal failure associated with ROPEE examinations and medications 12 17–27. None of these complications were observed during our study.…”

“…In addition to cardiovascular and respiratory effects, case reports and studies have documented NEC, seizures, anticholinergic syndrome, periorbital pallor and renal failure associated with ROPEE examinations and medications. 12 17–27 None of these complications were observed during our study. There is conflicting evidence in literature about clinically significant changes in blood pressure and respiratory rates in preterm infants following mydriatic use.…”

Implementation of optical coherence tomography in retinopathy of prematurity screening

“…Handheld WDFI devices used in bedside and telemedicine exams for ROP require similar preparation including bright light exposure which is physiologically stimulating [20,21]. In addition to stress during the exam, cycloplegic medication for pharmacologic dilation may cause systemic complications like impaired gut motility, require time for dilation, and incur cost of additional medication [22]. Handheld retinal imaging devices capable of noncontact photography may obviate the need for topical anesthesia, but they have lower field of view [23 ▪▪ ,24].…”