Long-term Glaucoma Outcomes in Adult Retinopathy of Prematurity

Abstract

Purpose: There is a paucity in the literature regarding long-term glaucoma outcomes of patients with cicatricial retinopathy of prematurity (ROP). We sought to estimate the incidence of glaucoma in this population and to determine how acute ROP treatment affects glaucoma incidence.

Methods: We performed a retrospective chart review of 426 eyes of 213 patients aged at least 15 years with a history of premature birth with gestational age less than 32 weeks seen at a single institution from October 1973 to August 2013. Glaucoma was defined as ocular hypertension requiring topical anti-hypertensive drops for more than 6 consecutive months outside an early postoperative period or requiring surgical intervention. Statistical analyses included t-test, Fisher’s exact test, and R².

Results: A total of 407 of 426 eyes were included in this cohort and followed for an average of 14.3 years (maximum of 35.7 years). Nineteen eyes were excluded because they were phthisical on presentation with limited ocular history prior to the development of phthisis. Of these, 155 eyes (38.1%) developed glaucoma. Subgroup analyses revealed an incidence of glaucoma of 23.2% (36 of 155 eyes) in eyes without a history of any treatment for acute ROP (spontaneously regressed), 23.3% (10 of 43 eyes) in eyes that underwent ablative therapy alone, and 58.5% (76 of 130 eyes) in eyes requiring incisional surgery (p < 0.01). Stage 4 eyes had a decreased incidence of glaucoma compared to Stage 5 eyes (40.5% vs. 66.7%, p < 0.01); however, among these, eyes that were phakic at last follow-up had a decreased incidence of glaucoma compared to those that were aphakic (27.8% vs. 69.8%, p < 0.01). The average cumulative incidence of glaucoma diagnosis was found to increase linearly for eyes with no history of acute ROP treatment (0.27% per year, R² = 0.97) and for eyes that underwent ablative therapy for acute ROP (1.25% per year, R² = 0.97).

Conclusions: ROP is a lifelong disease. Patients with a history of premature birth are at an increased risk of glaucoma, even if they did not receive intervention as an infant for acute ROP. More severe acute ROP is associated with higher rates of glaucoma later in life, and this may be associated with increased incidence of incisional surgical intervention in these patients. Ophthalmologists should be aware of the increased lifelong risk of adverse ocular sequelae in patients with a history of prematurity to help guide appropriate monitoring.