Corneal Complications in Preterm Infants
Jennifer Pan, MD; Gerard Barry, MD; Amir Bhatt, MD; Andrew Schneier; Alan Mulvihill; Shira Robbins; Kelli Coleman, MSIII; Alan Richards, MD
LSU Health Sciences Center
Introduction: The purpose of this study was to examine the incidence and spectrum of corneal complications among premature infants in the NICU.
Methods: Corneal problems among preterm infants were noted in our institution. A questionnaire-based survey was conducted among AAPOS members. Data on patient gestational age, number and type of corneal complications in preterm infants in the NICU was collected and analyzed.
Results: Thirty-two pediatric ophthalmologists reported corneal complications in preterm infants in the NICU. Eighty total cases of corneal complications were reported. Thirty cases occurred from exposure keratopathy. Thirteen cases of exposure keratopathy developed following laser for ROP. Thirty-one cases of ulcerative keratitis were observed: 17 cases were attributed to herpetic keratitis, 11 were bacterial ulcers and 3 were fungal ulcers. Eight corneal complications were due to trauma, six to anterior segment dysgenesis/Peters anomaly, four to glaucoma and one to rubella keratopathy. Analysis of gestational age revealed 26% of infants to be under 25 weeks, 55% at 26-29 weeks and 35% over 30 weeks. The majority (56%) of these cases were projected to sustain significant vision loss as a result of their corneal complication.
Discussion: Corneal disease and injury among preterm infants occurred from a wide variety of causes. Most infants were 29 weeks gestation or younger. Visual loss developed in a majority of cases.
Conclusion: Corneal complications affecting vision is not rare among very preterm infants. Vigilance by NICU nurses and neonatologists is critical. Protocols to protect corneas should be in place in each NICU.
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