Glaucoma in retinopathy of prematurity: A review

Glaucoma in retinopathy of prematurity (ROP) is a challenge. It is typically secondary, though it may be associated with primary congenital glaucoma. Secondary causes are multifactorial, with mechanisms and severity potentially linked to the stage of ROP, time of presentation, or interventions for its treatment. Anecdotal reports of glaucoma following anti-vascular endothelial growth factor injection exist, but conclusive evidence is lacking. The most important cause of glaucoma in ROP is secondary angle closure in patients with stage 5 ROP. Clinical features such as corneal clouding and increased corneal diameters are clues to diagnosing glaucoma; however, glaucoma may present much later in life as well, therefore, life-long follow-up of these patients is essential. Appropriate control of intraocular pressure (IOP) becomes imperative in infants with ROP as these eyes tend to enlarge quickly with raised IOP. Management strategies consist of medical therapy, angle-based surgery, filtration surgery, glaucoma drainage devices and cyclo-ablation. The choice of therapy is individualized according to the age, presentation of glaucoma, and visual potential. We review the epidemiology, etiology, natural history, risk factors, clinical features, investigations, differential diagnosis, management and outcomes of glaucoma in ROP.