Laser treatment for ROP may result in later abnormalities
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Retinopathy of prematurity patients treated with panretinal photocoagulation may present years later with the triad of pachyphakia, microcornea and angle closure, or PMAC, according to a presenter.
“Retinal ablation and heavy chorioretinal scarring may decrease the relative perfusion of the anterior segment, which could lead to the maldevelopment of the cornea and ciliary body ring and result in relative zonular laxity and pachyphakia,” Audina M. Berrocal, MD, said at the virtual American Society of Retina Specialists meeting.
Berrocal and colleagues performed two retrospective case control series evaluating young patients referred with angle closure to determine the incidence of and risk factors for acquired anterior segment abnormality after advanced retinopathy of prematurity (ROP) treatment.
The first series included 25 eyes of 14 consecutive angle closure patients. Nineteen eyes were treated for ROP and six eyes were full-term controls. Treated eyes had significantly shallower anterior chambers of 1.77 mm compared with 2.72 mm in full-term control eyes (P < .0001). Treated eyes had significantly thicker lenses of 5.2 mm compared with 3.98 mm lenses of control eyes (P = .0002).
The second series included 79 eyes of 40 patients with a median gestational age of 24.6 weeks. Eyes underwent treatment at a median of 36.3 weeks with 80% undergoing PRP and 20% undergoing intravitreal bevacizumab. No eyes received both.
At mean follow-up of 6 years, 10% of patients had acquired iridocorneal adhesion, which was associated with a past diagnosis of zone 1 disease and plus disease. Microcornea and pachyphakia were observed in all patients with angle closure who received PRP, Berrocal said.
“We postulate that it has to do with anterior segment ischemia at the time of laser, creating two things: a smaller cornea and zonular laxity that makes the lens become pachyphakic. A lot of these kids have lenses that are 5 mm in width or bigger, so by having this lens that’s so big in a smaller cornea, [it] pushes forward and closes the angle, and then you have PMAC,” Berrocal said in discussion of the presentation.
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Berrocal AM, et al. Long-term complications of laser treated infants with retinopathy of prematurity. Presented at: American Society of Retina Specialists annual meeting; July 24, 2020 (virtual meeting).
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