Ocular Hypertension in Adults with a History of Prematurity

Joshua Robinson; Albert Y Cheung; Eric Nudleman; Michael T Trese; Antonio Capone Jr; Kimberly A Drenser; George A Williams

doi:10.1016/j.oret.2017.10.005

Ocular Hypertension in Adults with a History of Prematurity

Ophthalmol Retina. 2018 Jun;2(6):629-635. doi: 10.1016/j.oret.2017.10.005. Epub 2017 Dec 1.

Authors

Joshua Robinson¹, Albert Y Cheung², Eric Nudleman³, Michael T Trese⁴, Antonio Capone Jr⁴, Kimberly A Drenser⁴, George A Williams⁵

Affiliations

¹ Emory Eye Center, Emory University Medical School, Atlanta, Georgia.
² Oakland University William Beaumont School of Medicine, Department of Ophthalmology, Royal Oak, Michigan.
³ Shiley Eye Institute and Jacobs Retina Center, Department of Ophthalmology, University of California, San Diego, La Jolla, California.
⁴ Associated Retinal Consultants P.C., Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Department of Ophthalmology, Royal Oak, Michigan.
⁵ Associated Retinal Consultants P.C., Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Department of Ophthalmology, Royal Oak, Michigan. Electronic address: gwilliams@beaumont.edu.

PMID: 31047618
DOI: 10.1016/j.oret.2017.10.005

Abstract

Purpose: To determine the ocular hypertension (OHT) incidence in patients with a history of prematurity and the effect of intervention for acute retinopathy of prematurity (ROP) in infancy on OHT incidence.

Design: Retrospective case series at a single tertiary referral vitreoretinal practice.

Participants: A total of 407 eyes of 213 patients were included, with ROP stage 0 to 5.

Methods: A retrospective chart review was conducted of patients aged ≥15 years, seen from 1973 to 2013, with a history of premature birth (gestational age <32 weeks). Data were collected from patient charts, including gender, date of birth, gestational age at birth, birth weight, stage of ROP at presentation, management (including laser, cryotherapy, lens-sparing vitrectomy [LSV], or lensectomy-vitrectomy). Ocular hypertension (if present) data included age of onset, timing of glaucoma surgery (if performed), lens status, and last follow-up examination.

Main outcome measures: Development of OHT, defined as eyes requiring a glaucoma medication for more than 6 consecutive months or surgical intervention for elevated intraocular pressure.

Results: Of included eyes, 155 (38.1%) developed OHT within 69 years of follow-up. Subgroup analyses revealed an OHT incidence of 23.2% (36/155 eyes) in eyes without a history of any treatment for acute ROP (spontaneously regressed), 23.3% (10/43 eyes) in eyes that underwent ablative therapy alone, and 58.5% (76/130 eyes) in eyes requiring acute incisional retinal surgery (P < 0.01). Stage 4 eyes had a lower OHT incidence compared with stage 5 eyes (40.5% [17/42] vs. 66.7% [54/81], P < 0.01); however, among stage 4 and stage 5 eyes, phakic eyes at last follow-up had a decreased OHT incidence compared with aphakic eyes (27.8% [5/18] vs. 69.8% [60/86], P < 0.01).

Conclusions: Patients with a history of extreme prematurity are at an increased risk of OHT and glaucoma, even if they did not receive acute ROP treatment. More severe acute ROP is associated with higher incidence of OHT, and this is associated with an increased incidence of incisional surgical intervention. Awareness of the increased lifelong risk of adverse ocular sequelae in patients with a history of prematurity will help guide appropriate monitoring.