Long-Term Results of Lens-Sparing Vitrectomy for Stages 4B and 5 Retinopathy of Prematurity

Abstract

PurposeTo assess long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) for treatment of tractional retinal detachments (TRDs) associated with stages 4B and 5 retinopathy of prematurity (ROP).MethodsWe performed a retrospective review of medical records and data analyses of consecutive patients who presented with stages 4B and 5 ROP and underwent LSV from 1999 to 2007. Retinal reattachment status, visual acuity and postoperative complications were evaluated.ResultsTwenty-one eyes of 20 patients, including 13 eyes with stage 4B ROP and 8 eyes with stage 5 ROP, were examined. The mean follow-up period was 5.6 years. In 9 (43%) out of 21 eyes, retinas were eventually reattached. The anatomic success rates were 62% in stage 4B and 13% in stage 5 ROP. In eyes with reattached retinas, visual acuity better than form vision was shown in 7 eyes (78%), whereas no light perception was present in 10 eyes (83%) among eyes with TRD on final examination. Postoperative intraocular hemorrhage occurred in nine eyes (43%). Long-term complications of cataract, corneal opacity, glaucoma and strabismus developed in 4 (19%), 6 (29%), 7 (33%) and 8 (38%) eyes, respectively, and were more common in eyes with TRD.ConclusionsAfter following-up for a mean of 5.6 years, the anatomical success rate of LSV was encouraging for the correction of TRD associated with stage 4B ROP but not for stage 5 ROP. Retinal reattachment is important for obtaining better visual outcomes and preventing the development of late complications.

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

“…Once retinal detachment occurs, the visual outcomes are generally poor (Quinn et al, 1991, Seaber et al, 1995, Trese and Droste, 1998, Shah et al, 2009b, Singh et al, 2012, with the best anatomical success rates at around 50% for stage 5 disease (Gadkari et al, 2015), but frequently as low as 15-25% (Shah et al, 2009b, Yu et al, 2006, Choi et al, 2011. Poor results and severe complications have been reported, even with lens-sparing vitrectomy (Yu et al, 2006).…”

Cataract surgery in children with retinopathy of prematurity (ROP): surgical outcomes

“…Cataract formation is a known risk factor after vitrectomy in cases with ROP. Choi et al 5 found that cataract developed in 19% of patients after LSV over a mean follow-up period of 5.6 years. In our series, the mean time to diagnosis of cataract after vitreous surgery was 7.76 months (range 2–32 months).…”

“…Cataracts in these infants may occur spontaneously or may be related to the interventions undertaken to treat the underlying retinal pathology, such as laser3 or vitreous surgery 4 5…”

Impaired Visual Fixation at the Age of 2 Years in Children Born Before the Twenty-Eighth Week of Gestation. Antecedents and Correlates in the Multicenter ELGAN Study

“…For example, changes in foveal architecture that reduce central acuity and thereby result in eccentric fixation have been reported in children who developed severe ROP, especially those who had a vitrectomy or retinal re-attachment surgery 12 .…”