RETCAM IN HEALTHY FULL TERM NEONATES: SEVEN YEARS STUDY

AND RESULTS IN 1606 NEWBORNS RETINAL SCREENING

EXAMINATION
Dra.Isabel Romagosa, Professor Dr.Jess Costa Vila. Grupo Oftalmolgico Admira
visin, Clnica Sagrada Familia, Barcelona (Spain). May 2013.
SUMMARY
Objective:
Perform systematically retinal and optic nerve examination in healthy full term neonates
with Retcam II (Clarity Medical Systems ) its a wide angle digital retinal image
acquisition system, to early detection of eye paediatrics pathologies and plan for therapy
in those possible patients to prevent visual loose or blindness ,and help in diagnosis to
exclude another associated systemic diseases. Study the differences between an
unknown normal full term newborns fundus , found pathology and compared with
adults retina.
Methods and material:
We offer newborns parents the chance to perform the screening of retinal exam.
Usually its performed 2 or 3 days after birth at safe nursery with dilate collyriums,
anesthetic and corneal gel protector drops to act as an interface between the fundus
camera and the cornea. Report results and digital images are given to the parents.
Results:
A total of 1606 healthy full-term neonates were explored in a period of seven years. 307
cases had ocular pathologies (19.12 %), including 287 cases with retinal hemorrhages
(17.87%). Retinal hemorrhages are the most frequently abnormality found in healthy
full-term newborn.
Conclusions:
Systematically complete ocular examination in healthy full term neonates including
fundus with the Retcam II, is a fast and safe method for the baby, about 10 minutes ,
and with proved efficiency to early detection of potentially grievous eye or systemic
paediatrics pathologies that can compromise health and the visual function and
determine which o them might quickly start treatment or systemic screening and follow
posterior development.
Key words:
Retcam screening, complete ocular examination, healthy full-tern newborn, dilated
retinal and optic nerve evaluation, retinal hemorrhages , grievous systemic diseases.
INTRODUCTION
Our Clinic is a private second level health center where weve about 2200 annual parts ,
and we offer newborns parents the chance to perform the screening of retinal exam
before they leave hospital or days after when mothers come for gynecological review.

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.

We classify retinal hemorrhages depending on its deep location in intraretinal (deep:

dot and blot hemorrhage, superficial: flame-shaped hemorrhage and hemorrhages with
white centers (Roths spots), preretinal (canoe and dome shaped) subretinal (
choroidal ) and vitreous hemorrhage. Multiple hemorrhages can coexist .
The hemorrhages are due to the birth trauma: its an ocular traumatic mechanism , due
to direct ocular compression or indirect(intracranial pressure, intrathoracic or abdominal
high level pressure, increase of intraocular venous pressure) when the baby overpass the
birth canal. During this compression or fit for hours previous to birth, it appears less
blood inflow in the ocular globe that causes a transient retinal ischemic, injuring the
endothelial cells and pericits from the vessels, breaking retinal capillary and
hematoretinal barrier ,so that we can typically see narrowed retinal arteries and dilatedirregular caliber veins but not tortuous, non exudate, non white ischemic, non optic disc
edema.
The normal newborn fundus discovery:
The abscense of the foveal light reflexe, arteries and venous caliber relationship
regarding adult is 1/3, arteries are thinnest and may be filiform, veins are bigger in
caliber and may be very dilated in all four quadrants ,or just lower or upper . In fetus,
retinal vasculature is completed nasal at eight month and temporal at nine ,and with
130 Retcam lense we can explore perfectly complete peripheral retina.
Clear eyes let us visualize the choroidal vascular pattern underlying, but very dark eyes
doesnt allow having good contrasted images because you must increase light
exploration level and is very uncomfortable for baby. High pigment eyes absorb the
light;both winger cases arent usually in our country.
DISCUSION
In our Clinic only a 10% of full-term annuals parts request for the Retcam fundus, and
is important to conscience parents and paediatrician on the importance of a early
diagnostics in pathologies like congenital glaucoma, retinoblastoma, optic nerve atrophy
or hypoplasia, Lebers congenital amaurosis at year, retinal and disc coloboma, anterior
segment and lens anomalies like aniridia, ectopia lentis, Riegers syndrome and others
which is important dismiss systemic abnormalities including tumours and neurological
involved that are vitals for the baby.
The Retcam fundus images are important in differential diagnosis with shaken baby
syndrome suspected, especially during the first three months before mostly extended
normal birth hemorrhages are absorbed in case of legal defence when baby abuse is
incriminate .
The follow up of extended hemorrhages involving macula in newborns let us study if
this may be a cause of posterior amblyopia in this children when they grow up.

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.

.Oftalmologa clnica. Jack J.kanski. Ed Elsevier 2009. Chap 16, Enfermedades

vasculares de la retina.
.Actualizacin en ciruga oftlmica peditrica. Agustin Fonseca. Ed Tecnimedia 2000.
Pt 3.ROP, Pt. 4 Retina, Pt.5 Retinoblastoma.

RE,normal fundus in full-term newborn

LE, intraretinal hemorrhages Grade I

LE, intraretinal hemorrhages Grade II

LE, intaretinal hemorrhages Grade II

RE intraretinal hemorrhages GII with white spot.

LE, intraretinal , superficials and deep hemorrhages

Grade III with macular affected.

LE, supeficial and deeps intraretinal -preretinal

and vitreous hemorrhages.

LE, Retinal and optic disc coloboma

RE ,dilated veins,Grade III hemorrhages

RE,,dilated veins,Grade III hemorrhages

RE, narrowed arteries

LE,G,rade III hemorrhages with,macular affected