title: Acute angle-closure glaucoma in retinopathy of prematurity following pupil dilation.
abstract: BACKGROUND
  Pupil dilation is a known risk factor for acute angle-closure glaucoma. Regular retinal evaluation is necessary for retinopathy of prematurity (ROP) cases. An acute attack of angle-closure glaucoma following pupil dilation in regressed ROP has never been reported.
  
  
  METHODS
  A five-year-old girl presented to the hospital for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She had a history of stage 4A ROP in the right eye and received scleral buckling. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) showed that the angle in the right eye was closed 360 degrees circumferentially. In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values. In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye.
  
  
  CONCLUSIONS
  Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future. Ophthalmologists should bear in mind that pupil dilation for a retina check-up could result in acute angle-closure glaucoma in ROP patients.
authors.affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Shiu-Chen
authors.initials: SC
authors.lastname: Wu
authors.affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Yung-Sung
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Wei-Chi
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan. hlc0625@hotmail.com.|Chang Gung University, College of Medicine, Taoyuan, Taiwan. hlc0625@hotmail.com.
authors.forename: Shirley H L
authors.initials: SH
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D033401:Microscopy, Acoustic; D009184:Mydriatics / Q000008:administration & dosage / Q000009:adverse effects*; D009883:Ophthalmic Solutions; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects; D011680:Pupil / Q000187:drug effects*; D012178:Retinopathy of Prematurity / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D012591:Scleral Buckling; D014130:Trabeculectomy; D014331:Tropicamide / Q000008:administration & dosage / Q000009:adverse effects; D014792:Visual Acuity / Q000502:physiology
chemical_list: D004338:Drug Combinations; D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine; D014331:Tropicamide