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LETTER TO THE EDITOR
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 44

Managing retinopathy of prematurity amidst hazy cornea


Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, New Delhi, India

Date of Submission10-Jun-2020
Date of Decision27-Jun-2020
Date of Acceptance27-Jun-2020
Date of Web Publication10-Apr-2021

Correspondence Address:
Siddharth Madan
Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_78_20

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How to cite this article:
Madan S. Managing retinopathy of prematurity amidst hazy cornea. J Clin Ophthalmol Res 2021;9:44

How to cite this URL:
Madan S. Managing retinopathy of prematurity amidst hazy cornea. J Clin Ophthalmol Res [serial online] 2021 [cited 2021 Jun 22];9:44. Available from: https://www.jcor.in/text.asp?2021/9/1/44/313478



Sir,

This is with reference to the recently published article by Narnaware and Bawankule.[1] The authors have mentioned the published case being first of its kind where they describe the management challenges faced in treating Type 1 early treatment of retinopathy of prematurity (ETROP)-Zone 2 posterior Stage 3 ROP with posterior plus disease, in a twin male infant (second twin expired) delivered at 28 weeks (Birth weight - 1000 g) who presented with concomitant corneal haze that cleared over a period of 4 months. The baby was diagnosed with Type 1 ETROP at postmenstrual age (PMA) of 32 weeks 5 days but had normal corneal diameters and intraocular pressures as evaluated under general anesthesia and he received treatment with hyperosmotic saline and steroid eye drops. The point worth writing this letter was to alert the ophthalmologists that corneal haze in premature infants is probably heterogeneous.[2] Preterm infants who have low birth weight and whose mothers have increased age have increased risk of developing corneal haze.[2] Moreover, central corneal thickness (CCT) in infants with corneal haze is not different from those without it and also the CCT of premature infants decrease as infants mature and so does the corneal haze. It is worth mentioning here that stage 3 ROP is reported as a one of the risk factors causing corneal haze in a retrospective study of 261 premature infants during ROP screening in the neonatal intensive care unit at a tertiary referral hospital.[2] This study also noticed that corneal haze that was associated with stage 3 ROP usually lasts until 40 weeks PMA. Although the final outcome was satisfactory in the case of this preterm infant where partial laser followed by intravitreal ranibizumab (IVR) injection in both eyes and laser augmentation performed subsequently, an alternative approach that could have been considered was to administer IVR injection under topical anesthesia as the first line of management in this neonate having hazy cornea with Zone 2 posterior stage 3 ROP with plus disease.[3],[4] Hazy media usually precludes performing laser with precision. Vascular endothelial growth factor (VEGF) is well-established contributor in the pathogenesis of corneal neovascularization and development of corneal haze.[5] IVR may possibly reduce the VEGF load in the eye and may help in reduction of corneal haze that may partly be inflammatory in origin. Furthermore, it is well supported in literature that IVR in ROP gives retina a chance to vascularize significantly and IVR not only limits the progression of ROP but also makes it amicable to improvement in case subsequent surgical treatment is required. Surgical outcome is better in neonates treated with IVR as compared to those who underwent laser primarily.[3],[4] Babies are still amenable to laser post-IVR without sedation or general anesthesia.[4] IVR with or without subsequent laser by 10 weeks of IVR is a safe and effective treatment option in the management of ROP especially in zone 1, posterior zone 2 disease, and also in Aggressive posterior ROP.[3],[4] Laser remains the gold standard treatment for ROP; however, the introduction of IVR has brought a paradigm shift in managing these preterm infants with ROP, a potentially sight threatening cause for childhood blindness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Narnaware SH, Bawankule PK. Type 1 early treatment of retinopathy of prematurity with corneal haze? Cause. J Clin Ophthalmol Res 2020;8:30-1.  Back to cited text no. 1
  [Full text]  
2.
Lai YH, Chen HL, Yang SN, Chang SJ, Chuang LY, Wu WC. The characteristics of premature infants with transient corneal haze. PLoS One 2018;13:e0195300.  Back to cited text no. 2
    
3.
Zhang G, Yang M, Zeng J, Vakros G, Su K, Chen M, et al. Comparison of intravitreal injection of ranibizumab versus laser therapy for zone ii treatment-requiring retinopathy of prematurity. Retina 2017;37:710-7.  Back to cited text no. 3
    
4.
Beri S, Madan S, Shandil A, Nangia S, Garg R, Virmani P. Management of retinopathy of prematurity: Quest for the best. Official Sci J Delhi Ophthalmol Soc 2020;30:27-31.  Back to cited text no. 4
    
5.
Roshandel D, Eslani M, Baradaran-Rafii A, Cheung AY, Kurji K, Jabbehdari S, et al. Current and emerging therapies for corneal neovascularization. Ocul Surf 2018;16:398-414.  Back to cited text no. 5
    




 

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