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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 11  |  Page : 1876-1877

Up close with the vascular loops in aggressive posterior retinopathy of prematurity


1 Consultant Vitreoretinal Surgeon, Department of Vitreoretinal Diseases, Dr. NSD Raju's Eye Hospital and Research Centre, Vyttila, Kerala, India
2 Head of Vitreoretinal Services, Department of Vitreoretinal Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
3 Department of Ophthalmology, Lakshmi Hospital, Kochi, Kerala, India
4 Medical Director, Cataract and Anterior Segment Services, Dr. NSD Raju's Eye Hospital and Research Centre, Vyttila, Kerala, India

Date of Submission04-Jun-2019
Date of Acceptance23-Jul-2019
Date of Web Publication22-Oct-2019

Correspondence Address:
Dr. Biju Raju
Consultant Vitreoretinal Surgeon, Dr. NSD Raju's Eye Hospital and Research Centre, “Ranjini” Near Powerhouse, Vyttila, Kochi - 682 019, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1086_19

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  Abstract 


Keywords: Aggressive Posterior Retinopathy of Prematurity, Vascular Loops, Laser Indirect Ophthalmoscopy, Anti-VEGF


How to cite this article:
Raju B, Jalali S, Balamani D, Raju N S. Up close with the vascular loops in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol 2019;67:1876-7

How to cite this URL:
Raju B, Jalali S, Balamani D, Raju N S. Up close with the vascular loops in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol [serial online] 2019 [cited 2019 Nov 13];67:1876-7. Available from: http://www.ijo.in/text.asp?2019/67/11/1876/269599



A premature baby born at 29 weeks, with a birth weight of 1.091 Kg was screened and diagnosed to have aggressive posterior retinopathy of prematurity (AP-ROP)[1] at 33 weeks of gestational age. Photo documentation using a do-it-yourself smartphone fundus camera adapter (DIYretCAM),[2] showed plus disease and flat neovascularization in Zone 1 and posterior Zone II in the left eye [Figure 1]. The right eye had more severe disease with media haze precluding proper fundus documentation. A zoomed-in fundus photograph with the DIYretCAM documented the extensive areas of intraretinal vascular shunting [Figure 2]. This close-up fundus photograph shows that these vascular loops involve a broad area of the retina. When such vascular loops contract, it rapidly leads to retinal detachment with extensive contraction of the retina, thus making these detachments difficult to manage. Though intravitreal Anti-Vascular Endothelial Growth Factor (Anti-VEGF) has been recommended for such cases, we chose to treat the baby with conventional laser indirect ophthalmoscopy (LIO) alone.[3] After three sessions of laser photocoagulation at weekly intervals for both eyes, there was adequate regression of AP-ROP [Figure 3]. This photo essay documents the appearance of the vascular loops in AP-ROP, up close, with a cost-effective method, which is not possible with the currently available neonatal wide-angle fundus documentation techniques.
Figure 1: Montage of the left eye fundus showing plus disease, retinal hemorrhage and flat neovascularization with extensive intraretinal shunting, retinal hemorrhages and vascular loops in Zone I and posterior Zone II typical of AP-ROP

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Figure 2: Close-up view of the same eye showing vascular loops and intraretinal vascular shunting within the flat neovascularization in AP-ROP

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Figure 3: Montage showing completely regressed AP-ROP in the same eye with a favorable outcome after LIO

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005;123:991-9.  Back to cited text no. 1
    
2.
Raju B, Raju N, Akkara JD, Pathengay A. Do it yourself smartphone fundus camera – DIYretCAM. Indian J Ophthalmol 2016;64:663-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Jalali S, Kesarwani S, Hussain A. Outcomes of a protocol-based management for zone 1 retinopathy of prematurity: The Indian twin cities ROP screening program report number 2. Am J Ophthalmol 2011;151:719-24.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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