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 [Fig. 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 [Fig. 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 [Fig. 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
Figure 2.
Close-up view of the same eye showing vascular loops and intraretinal vascular shunting within the flat neovascularization in AP-ROP
Figure 3.
Montage showing completely regressed AP-ROP in the same eye with a favorable outcome after LIO
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Conflicts of interest
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References
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