Abstract
Purpose :
Anatomical narrow angle and glaucoma from increased lens thickness, and/or scarring and forward displacement of the lens-iris-diaphragm can result from threshold retinopathy of prematurity (ROP) treated with laser or cryotherapy. This study investigates the efficacy of lensectomy in treatment of anterior chamber angle narrowing in ROP patients.
Methods :
This retrospective study was approved by the Vanderbilt University Medical Center (VUMC) Institutional Review Board and Vanderbilt Institute for Clinical and Translational Research (VICTR). The cohort was identified by querying the VICTR Research Derivative database for clinical data (1995-2020) derived from the VUMC’s clinical systems and restructured for research. Patients were identified by ICD-9 or ICD-10 codes for 1) ROP and 2) narrow angle or glaucoma. Patient demographics and clinical course as available in the medical records were recorded in a secure format, including: sex, post-conceptual birth age, treatment of ROP, age at diagnosis of anatomical narrow angle or angle-closure glaucoma, glaucoma medication use, iris procedure performed and outcome, age and angle status at lensectomy, and final outcome. Descriptive statistics were performed.
Results :
Initial query yielded 70 patients. 42 patients were excluded for 1) no evidence of narrow angles 2) prematurity without ROP, and 3) limited medical record information/follow up. Of the remaining 28 patients, 48 eyes demonstrated narrow angle or glaucoma: 53.6% were female, mean post-conceptual birth age was 25.1 (23-28) weeks, 90.9% of patients required treatment for ROP. Mean and median age at diagnosis of anatomical narrow angle or angle-closure glaucoma were 9.5, 15 (1-37) years. 66.7% of eyes with narrow/closed angles underwent iridotomy/iridectomy +/- iridoplasty shortly after diagnosis. 57.6% of these eyes subsequently required glaucoma medication. Mean and median age at lensectomy for treatment of narrow angle or angle-closure were 20.3, 17 (2-38) years, with 47.8% occurring during teenage years. Deepening of the anterior chamber occurred in 19/23 eyes after lensectomy.
Conclusions :
This case series demonstrated: 1) continued monitoring of patients with history of ROP and narrow angles is crucial into adulthood especially during the teenage years and 2) lensectomy in patients with refractory or progressive narrow angles after iridotomy/iridectomy +/- iridoplasty is efficacious.
This is a 2021 ARVO Annual Meeting abstract.