March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
New Insights in Retinal Vascular Morphology in Neonates with Congenital Heart Disease
Author Affiliations & Notes
  • Axel Orozco-Hernandez
    Retina, APEC, Mexico City, Mexico
  • Fernando Schoonewolff
    Retina, APEC, Mexico City, Mexico
  • Jeanette Mercado
    Neonatal Intensive Care Unit, Instituto de Salud del Estado de Mexico, Toluca, Mexico
  • R.V. Paul Chan
    Retina, New York Presbyterian Hospital Weill Cornell Medical College, New York, New York
  • Virgilio Morales-Canton
    Retina, APEC, Mexico City, Mexico
  • Gerardo Garcia-Aguirre
    Retina, APEC, Mexico City, Mexico
  • Maria Ana Martinez-Castellanos
    Retina, APEC, Mexico City, Mexico
  • Footnotes
    Commercial Relationships  Axel Orozco-Hernandez, None; Fernando Schoonewolff, None; Jeanette Mercado, None; R.V. Paul Chan, None; Virgilio Morales-Canton, None; Gerardo Garcia-Aguirre, None; Maria Ana Martinez-Castellanos, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 5868. doi:
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      Axel Orozco-Hernandez, Fernando Schoonewolff, Jeanette Mercado, R.V. Paul Chan, Virgilio Morales-Canton, Gerardo Garcia-Aguirre, Maria Ana Martinez-Castellanos; New Insights in Retinal Vascular Morphology in Neonates with Congenital Heart Disease. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5868.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : The aim of the present study is to report the ocular findings in neonates with congenital heart disease, with novel descriptions in retinal vascular changes demonstrated by wide field fundus images and fluorescein angiography (FA).

Methods: : Retrospective case series including four eyes of infants with complicated congenital heart disease in the Neonatal Intensive Care Unit (NICU) who underwent complete systemic and ophthalmologic evaluation, including 120 degrees wide-field color fundus imaging and FA (RetCam II, Clarity Medical Systems, Inc.)

Results: : The identified anatomic cardiac anomalies were persistence of arterial conduct with pulmonary hypertension and interventricular communication with left ventricle hypertrophy, both with hypertrophic cardiomyopathy. After a complicated course in the NICU, both infants died of cardiogenic shock. One patient was a 32 week preterm neonate with retinopathy of prematurity (ROP) and thrombocytopenia, the other was full term. Ophthalmologic evaluation and FA showed in all eyes venous tortuosity in the posterior pole as well as in the extreme periphery. At first, retinal vascular tortuosity of the preterm infant was thought to be plus disease of an Aggressive Posterior ROP (APROP), because of its association with thrombocytopenia, nevertheless FA showed zone 2, stage 1 ROP without plus disease or neovascularization and no progression was seen within the follow-up.

Conclusions: : We demonstrate an early characteristic retinal vascular tortuosity pattern in neonates with congenital heart disease and hypertrophic cardiomyopathy. This vascular tortuosity suggested plus disease in the preterm infant. However, as FA and follow-up demonstrates no neovascularization or progression and also these findings were present in a non-ROP patient, we concluded that the clinical picture was related to congenital heart disease and should not be confused with the plus disease or APROP seen in premature babies.

Keywords: retinopathy of prematurity • retina • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) 

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