Acute Severe Retinopathy of Prematurity (ROP) in VLBW Twin Sisters: Anterior and Posterior Segment Findings as Seen With Serial Digital Wide Field Imaging

Abstract

Abstract: : Purpose: To describe anterior and posterior segment findings in VLBW twin sisters with acute severe ROP. Methods: BL and BS (GA 25+4 wks, BW 710 g and 740g) were screened for acute ROP with a digital wide field camera (RetCam 120) according to German National Guidelines¹. Serial follow–up examinations with the RetCam 120 documented the clinical course of the disease. The infants were participants of the Bavarian Multicenter Telemedical Project, that is aimed to improve ROP screening^2–3. Results: At the first examination (PMA 31 +4, PNA 6 wks) both twins presented with a persistent tunica vasculosa lentis. The border of vascularisation in BL was in zone I with thin vessels and otherwise no signs of acute ROP. In BS the border of vascularisation was in posterior zone II. Weekly follow–up examinations were scheduled. In BL, at PMA 33 wks – PNA 8 wks, plus disease had developed with intraretinal tuft–like vessel proliferation and sparse retinal hemorrhages at the border of vascularisation but no ridge formation. Tunica vasculosa lentis with hyperemic iris was persistent. Diode laser coagulation (DLC) of the avascular retina was performed within 72 hours. Hyperemic tunica vasculosa lentis persisted. A second DLC was performed at PMA 34 wks – PNA 9 wks followed by transscleral cryocoagulation to the persistent vascular proliferations at the border of the DLC scars at PMA 37 wks – PNA 12 wks. A dilated tunica vasculosa lentis was still persistent at the time of cryo. Twin BS developed ROP stage 3+, zone II with a persistent, hyperemic tunica vasculosa lentis at PMA 34 wks – PNA 9 wks. DLC of the avascular retina was performed. Tunica vasculosa lentis regressed together with regression of acute ROP following DLC. Conclusions: Persistent and dilated tunica vasculosa lentis is a marker for acute severe ROP that may require treatrment. In zone I disease short term follow–up examinations and timely DLC at the appearance of plus disease of stages 1 and 2 is crucial. DLC to the posterior and temporal retina required higher power than DLC to the anterior and nasal retina. 1. Clemens S et al. Ophthalmological screening studies in newborn infants. German Ophthalmological Society] Ophthalmologe. 1999 Apr;96(4):257–63 2. Lorenz B, Elflein H. Preventing blindness in premature infants: A telemedical solution gains acceptance. Neonat Intens Care (2002) 15:42–48 3. Elflein H, Lorenz B. Wide–Field–Digital–Imaging Based Telemedicine for Screening of Acute Retinopathy of Prematurity (ROP). Eighteen–Month Results of a Multicenter Study. Submitted

Keywords: retinopathy of prematurity • retina