Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Usually is performed 2 or 3 days after birth, with parents signed consent and asked for
family clinical history of eye or systemic diseases. The test is done at nursery for added
safety. In our study the mothers gestational age is always over 36-40 weeks and no
less, because we dont have premature unit.
METHODS AND MATERIAL
The technique: first we explore external eye to exclude infection, and confirm anterior
segment is normal and able to dilate pupils. Before dilate, we can also use Retcam 130
lens to explore the anterior chamber angle, as a gonioscopic evaluation, inclining 45
the camera, with a great of carbomer gel over de cornea. We use collyrium of
cycloplegic 0.5% and Phenylephrine 0.25 %, 1 drop of both, 60 and 30 minutes before
the examination.
One hour later we numb the eyes surface with anesthetic combined drops of tetracaine
clorhidrate 1mg and oxibuprocain clorhidrate 4mg. We insert an eyelid speculum for
keeping the eyelids opened and uneplace a corneals gel protector of carbomer to act as
an interface between the camera and the cornea.
The camera has various interchangeable lenses. First we use the portrait one for external
eye and newborn face image ,and with 130 lens we take corneal contact for dilated
fundus images acquisition .During 40 seconds we record a video for each eye and
examine posterior segment at different angles to provide a complete retinal exploration.
The imaging process is performed by an ophthalmologist doctor. Its very important to
keep a good technique and direct retinal visualization .All the procedure takes about 10
minutes and we review the video and evaluate the digital images, select and print some
of them with a written report for the parents.
RESULTS
Weve performed the screening exploration in a total of 1606 healthy full-term neonates
in a period of seven years, beginning in May 2006 until May 2013. Our study
accumulates the following data: 1299 were normal ocular exam (80.88%), 307 cases
had ocular pathologies (19.12 %), including 287 cases with retinal hemorrhages
(17.87%) and 20 cases with other ocular pathologies (1.25%), including subconjunctival
and eyelids hemorrhage , dilated retinal venous , congenital cataract, optic nerve and
retina coloboma, congenital hypertrophy RPE, lacrimal obstruction, Sturge -Webber
syndrome, icterus, microphthalmos, aniridia and strabismus.
Retinal hemorrhages are the most frequently abnormality found in healthy full-term
newborn.
We divided hemorrhages depending on its extension in 3 grades and the rates were: 196
grade I or mild ( 68.29 % ),66 grade II or moderate (23%) , 46 grade III or extended
(16.03%) . The incidence of macular hemorrhage independent from grade were 36 cases
(12.54 %.), and in 196 newborn ( 49%) retinal hemorrhage involved both eyes.
The retinal hemorrhages are more frequently in natural birth babies, especially in
interventionist-birth like forceps, scoops and sucker, and not found in cesarean .
We perform a new fundus exam to confirm extended and macular hemorrhages will be
absorbed in 3 months, but most of mild( GI ) and moderate ( GII),about 70 % ,do it in
the first month.
References:
.Retina. American Medical Asociation, David A.Quillen. Ed .Marban 2005. Chap.3,
5,8,10,12,13.
.Oftalmologa, American Medical Association, Daniel H.Gold. Ed.Marban 2005.
Chap.9 Retina.