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NP-006 Early detection of retinopathy in premature infants using mixture of eye drops with 2.5% phenylephrine hydrochloride and 0.5% tropicamide
  1. B Alihodzic-Dilberovic1,
  2. M Mandžo1,
  3. D Zvizdic2
  1. 1Clinical Centre of the University of Sarajevo, Clinical Pharmacy, Sarajevo, Bosnia–Herzegovina
  2. 2Clinical Centre of the University of Sarajevo, Eye Disease Clinic, Sarajevo, Bosnia–Herzegovina


Background Retinopathy of prematurity (ROP) is an eye disease that can happen in premature babies. It causes abnormal blood vessels to grow in the retina and can lead to blindness. Birthweight and gestational age are the most important risk factors in the development of severe ROP. Phenylephrine and tropicamide are most commonly used as mydriatic agents for eye examination.

Purpose Using a combination of 2.5% phenylephrine hydrochloride and 0.5% tropicamide drops, in the Neonatal Intensive Care Unit (NICU), help us to discover abnormality in retinal vascularisation in the initial phase of retinopathy. This helps in effective medical treatment and healthy visual function.

Material and methods One-thousand, five-hundred and forty premature infants with a gestational age between 26 and 32 weeks and/or birthweight between 680 g and 2100 g were examined by binocular indirect ophthalmoscopy between 2 to 4 weeks after birth, and followed up until retinal vascularisation was complete. Pupillary dilatation was done with a mixture of 2.5% phenylephrine hydrochloride and 0.5% tropicamide and instilled twice at intervals 1 hour before examination. The eye drops were prepared in our clinical pharmacy. In order to identify the stage of premature retinopathy, and eye examination was repeated every 7 to 10 days. Depending on the results, the term of the next examination was determined every 7 to 14 days. Once the regression was achieved in two consecutive examinations, the monitoring was done once a month.

Results In this study, a total of 1540 premature infants were screened from 10 May 2017 to 16 May 2018. Maximal pupil dilatation was achieved with a mixture of 2.5% phenylephrine hydrochloride and 0.5% tropicamide. All examined infants had some type of ROP. Some children had spontaneous regression. Four infants had ROP that had to be treated with anti-VGF therapy within 24 to 72 hours.

Conclusion The early detection of ROP in premature and very-low-birthweight infants is crucial. Screening programmes for ROP should be implemented in every NICU and should be carried out by an experienced ophthalmologist and offered to all premature infants with birthweight of ≤2100 g or gestational age of ≤32 weeks to ensure early detection and timely treatment of threshold ROP to prevent its blinding sequelae.

References and/or acknowledgements None.

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