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Retinopathy of prematurity
  1. Walton Hospital, Rice Lane
  2. Liverpool L9 1AE

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    Editor,—Treating retinopathy of prematurity (ROP) is a procedure requiring significant degrees of skill and patience. The surgeon usually has to treat the peripheral retina, a task that is frequently made difficult because of the small eye in the premature baby and also because in many cases visualisation is further complicated by poor pupillary dilatation secondary to the disease process. Optical clarity, for laser treatment in particular, is therefore of paramount importance in attempting to maintain adequate visualisation in these difficult cases. However, it is unavoidably compromised as a result of corneal drying necessitated by the need not only for a speculum but also because the background ambient temperature is frequently elevated above normal ‘room temperature’. Corneal clarity is maintained by the application of balanced salt solution (BSS) or hypromellose 0.3% drops which are administered by an assistant at ‘convenient’ moments during the procedure.

    Ocucoat (Storz Ophthalmics Products) is a sterile, non-pyrogenic, optically clear viscoelastic material containing 2% hydroxypropyl methylcellulose. It is usually indicated as a surgical aid in procedures of the anterior segment of the eye, most commonly cataract surgery.1-4 It is supplied in a 1 ml single use glass syringe.

    Recently, we have used Ocucoat, instead of hypromellose drops as an aid to improving and maintaining optical clarity during the treatment of ROP. We find that it permits excellent visualisation and because of the viscous nature of the material it remains in situ throughout the procedure. Its ocular safety is beyond any reasonable doubt and indeed we have seen no adverse effects on the eye since we began using Ocucoat; but nevertheless we irrigate the eye thoroughly on completing the treatment. We also find that the wetting effect of Ocucoat can be prolonged by the occasional administration of hypromellose drops.

    In conclusion, we have found the viscoelastic Ocucoat, most commonly used in intraocular surgery, to be a valuable adjunctive tool in the management of threshold ROP. Finally, we have no commercial interest in the product.