A newly turned 60-week-old blind baby boy with Stage 3 Retinopathy of Prematurity, who was delivered prematurely at 27 weeks via an emergency Caesarean section to a mother with gestational diabetes, had glimmers of hope in his eyes. This condition, which is characterized by abnormal blood vessel growth in the retina, compromises eyesight resulting in blindness and is most commonly observed in preterm infants.
The Arab male infant, weighing barely 900grams who had to spend nearly 92 days at the Neonatal Intensive Care Unit (NICU) after birth, underwent a groundbreaking procedure at Medcare Eye Centre on Sheikh Zayed Road to regain his sight. Witnessing their baby’s extraordinary recovery offered an enormous sense of serenity and comfort to his parents, whose road had been fraught with uncertainty since his early birth.
Shock set in for the anguished parents of the infant warrior as they had conflicting emotions in celebrating the arrival of their tiny bundle of joy. “I didn’t think he had a chance,” the hapless mother of the infant explained. “You can’t look at such a tiny baby and think this is going to be alright.” Meanwhile, a team of multi-disciplinary healthcare professionals from the hospital’s Neonatal Intensive Care Unit (NICU) worked tirelessly to save the infant boy, who had chronic lung illness and needed mechanical ventilation to breathe. Given that he was delivered prematurely due to complications caused by his mother’s gestational diabetes, loss of vision at birth was a common health concern. Despite the neonatal challenges, the infant’s parents were unaware that anything was abnormal with his vision while he was recuperating in the NICU. Dr. Prasan Rao noticed the infant’s inability to respond to visual cues during a routine NICU assessment at 33 weeks.
“I was overwhelmed with worry, fear and helplessness. Seeing my fragile newborn struggling was incredibly distressing, but I held onto hope and prayed for his strength and resilience,” expressed the mother, reflecting on the tumultuous experience.
Commenting on the diagnosis, Dr. Prasan Rao, Specialist Ophthalmologist at Medcare Eye Center, said, “The condition called ROP necessitates immediate action to safeguard the baby’s vision and overall well-being as vision impairment in infancy can have profound consequences on the quality of life. Thus, our medical team swiftly devised a comprehensive treatment plan involving meticulous monitoring and therapeutic interventions aimed at halting the progression of ROP and preserving the baby’s sight.”
“We provided the infant with a treatment involving bilateral intravitreal injection to address the aggressive ROP. This procedure entails injecting medication directly into the eye to inhibit the growth of abnormal blood vessels in the retina,” he continued.
Unfortunately, at around 42 weeks, there was a recurrence of stage three ROP, the growth of abnormal blood vessels in the retina, in both eyes of the infant, accompanied by signs of worsening eye condition known as plus disease. Due to a more critical location of the ROP in the eyes, Dr. Rao decided to administer another round of intravitreal injections instead of using a laser treatment to cause regression of the abnormal blood vessels. By and large, most of the eyes with ROP stabilize with one intravitreal injection, however due to disease recurrence with a relatively larger area of retina devoid of blood vessels, additional intravitreal injection was planned.
“Early diagnosis and intervention are paramount in safeguarding a premature infant’s vision, especially in cases of ROP. ROP rarely recurs following the intravitreal injection treatment, necessitating retinal laser photocoagulation, which is an eye procedure that uses a laser to reduce or eliminate aberrant growth of blood vessels in the retina leading to retinal detachment. However, because of the posterior nature of the recurrence in this case, we decided to administer the intravitreal injection again. This underscores the importance of tailored approaches in managing complex cases to ensure the best possible outcomes. By ensuring optimal care, we can strive to improve outcomes for these vulnerable patients,” Dr. Rao said.
Nonetheless, the ordeal was far from done for the parents. By 60 weeks, the baby still had areas in both eyes, where the retina lacked adequate blood vessels.
Dr. Rao elaborated: “We followed a multi-step strategy. First, the infant had fundus fluorescein angiography, which involves injecting a specific dye into the veins to reveal the abnormal retinal blood vessels. Following that, we performed peripheral retinal ablation, which involves employing a laser to coagulate areas of the retina with insufficient blood flow. The decision to proceed with retinal laser photocoagulation was made, targeting areas of the retina with absent blood flow to prevent ROP progression.”
Following the successful surgery, the infant’s retinal health improved. However, Dr. Rao noted that the infant still needed close monitoring, citing concerns about the development of bilateral esotropia, a condition in which the eyes turn inward that necessitates continuous evaluation and possible refractive error with need for glasses.
Speaking about their arduous journey, the baby’s parents said, “We were filled with worry as we watched our little one bravely battle through this uphill struggle, but seeing his strength and resilience filled us with pride. Now that this ordeal is finally over, we cannot express enough how thankful we are for the exceptional care provided by Dr. Rao and the entire medical team at Medcare. Their dedication and expertise gave us hope during our darkest moments.”
While there are still concerns, presently, the infant now has the opportunity to lead a full life with restored vision. As he and his family embark on a positive journey together, they can approach life with optimism and potential, equipped to explore the world and its possibilities like any other child.
