Case Report: Glaucoma in an Infant With Retinopathy of Prematurity

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.

Intraocular Pressure Values using Icare® Rebound Tonometer and Correlation with Postconceptional Age in Premature Infants

“…There are other proposed physiopathological mechanisms that may cause increases in IOP measurements which are not unique to ROP but are related to prematurity in itself such as incomplete trabecular meshwork development, decreased anterior chamber depth, anteriorly displaced iris planes, and increased lens thickness. [ 9 ] In our study, we only included a small number of children with early stages of ROP (stage I or II). As none of them were submitted to laser or to anti-VEGF therapy that could alter IOP values, it is highly unlikely that early ROP changes would lead to significant IOP changes in these eyes and we chose to include them in the study.…”