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Introduction
In prematurely born infants, cataracts may preclude examinations and treatment for retinopathy of prematurity (ROP). The decision when to surgically remove the cataracts is complex and influenced by many factors, including general health of the infant, risk for development of ROP requiring treatment, and potential complications of cataract surgery at an early age. Herein, we report our experience with such a case.
Case Report
A female infant was born at 23 weeks' gestational age weighing 620 g. The pregnancy was complicated by twin-to-twin transfusion; laser ablation of connecting blood vessels between the twins was done at an outside hospital. Maternal screening during pregnancy included blood type (A+), group B Streptococcus species (negative), hepatitis B (negative), HIV (negative), and rubella serologies (non-reactive). The patient was born as Twin B by emergency caesarian section for purulent cervical discharge and contractions. Twin A died shortly after delivery. The patient had APGAR scores of 1 at 1 minute, 5 at 5 minutes, and 7 at 10 minutes. She was limp and apneic, the heart rate was less than 100 beats per minute, and she required intubation in the delivery room. Her 4-month stay in the neonatal intensive care unit was significant for pneumopericardium requiring chest tube placement, presumed sepsis (negative blood and cerebrospinal fluid cultures), neutropenia, bilateral intraventricular hemorrhage grade II, ventricular septal thickening with atrial septal defect that resolved, and anemia requiring several red blood cell transfusions and one platelet transfusion. Medications administered in the neonatal intensive care unit included surfactant, vitamin A, caffeine, furosemide, spironolactone, cholorthiazide, dexamethasone, dopamine, hydrocortisone, ampicillin, gentamicin, ceftriaxone, vancomycin, indomethacin, and sodium supplements.
Initial ROP evaluation done in the seventh week of life (post-menstrual age [PMA] = 29 to 30 weeks) showed immature retinal vessels in zone II in both eyes. At 32 weeks' PMA, a central lens opacity was noted in both eyes, along with stable retinal findings. In the tenth week of life (33 weeks' PMA) there was no fundus view in either eye due to dense cataracts. Work-up for congenital cataracts (cytomegalovirus, Epstein--Barr virus, varicella, and galactosemia urine screen) was negative (it was performed before the family history of hereditary cataracts was obtained by our service). The family history was positive for congenital cataracts in the mother, sister,...