Late Occurrence of Narrow Angles and Angle Closure Glaucoma in Patients with Treated Retinopathy of Prematurity

Abstract

Purpose: : Patients with retinopathy of prematurity (ROP) are known to be at risk for neovascular glaucoma that typically occurs during infancy due to retinal ischemia. We report our experience with narrow angles and angle-closure glaucoma occurring later in life in patients who have been successfully treated for ROP.

Methods: : Retrospective medical record review of patients previously treated for ROP who were evaluated and treated for either narrow angle or acute angle closure glaucoma.

Results: : Twelve patients with a history of ROP that was treated by either laser or cryotherapy were identified. Three patients required vitrectomy. Their estimated gestational ages ranged from 24 to 32 weeks (average 26.7 weeks). The birth weight ranged from 495 g to 1125 g (average 849.3 g). Age of presentation for evaluation and management of either anatomically narrow angle or acute angle closure glaucoma ranged from 8 to 30 years old (average 18.7 years). Axial length ranged from 19.04 to 30.30 mm (average 22.05 mm). Spherical equivalent refractive error ranged from +1.75 to -28.0 D (average -7.36 D). Nine eyes among these patients had elevated intraocular pressure ranging from 21 to 59 mmHg (average 43.7 mmHg). All but one eye was treated with laser peripheral iridotomy (LPI). Lensectomy was required in 5 eyes to relieve the phacomorphic component to the crowded anterior segment. One eye required filtration surgery.

Conclusions: : In addition to early glaucoma complications due to ischemia and ROP, late onset angle-closure glaucoma should be considered as a possible complication of ROP. Most cases had axial hyperopia, but some eyes had complex biometry with axial myopia combined with relative anterior microphthalmos. In addition to LPI for pupillary block mechanism, lensectomy is an option to manage the phacomorphic component of glaucoma.

Keywords: retinopathy of prematurity