Immediate Sequential Bilateral Vitrectomy Surgery for Retinopathy of Prematurity: A Single Surgeon Experience

Abstract

Objectives: We report the safety and efficacy of simultaneous bilateral vitrectomy for stage 4 and stage 5 retinopathy of prematurity (ROP). Materials and Methods: Babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were included in this retrospective study. Clinical history, demographic characteristics of the patients, surgical procedure details, perioperative and postoperative ophthalmic and systemic complications, and postoperative anatomical success rates were evaluated. General anesthesia features were also recorded. Results: Seventy eyes of 35 babies who had immediate sequential bilateral vitrectomy surgery for stage 4 or stage 5 ROP were reviewed. At the time of surgery, the mean age was 41.4±4.9 weeks. There was preoperative plus disease in 58.6% of the eyes. The mean surgery/eye ratio was 1.2. Mean anesthesia time was 95±64 minutes. The mean follow-up was 28.1 months (3 to 84 months). Anatomical success was 95.7% for stage 4A (44/46 eyes), 83.3% for stage 4B (15/18 eyes), and 50% for stage 5 (3/6 eyes) ROP. Patients with stage 5 ROP had significantly less anatomical success than stage 4A and 4B (p=0.004). None of the patients had endophthalmitis and anesthesiarelated severe complications. Conclusion: Immediate sequential bilateral vitrectomy surgery can be considered an option for patients with active bilateral stage 4 and stage 5 ROP. The risk of endophthalmitis should be weighed against the risks of disease progression and anesthesia-related complications.

Anatomic and Functional Outcomes of Vitrectomy for Advanced Retinopathy of Prematurity: A Systematic Review

“…Ten studies (one prospective and nine retrospectives) involving 782 patients (1179 eyes) were eligible. [ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] The quality of all studies was good according to the NIH quality assessment tool [Table 1]. These studies were conducted in different parts of the world: five were conducted in India, [ 1 , 16 , 17 , 20 , 21 ] three in Turkey, [ 13 , 14 , 18 ] one in Italy, [ 15 ] and one in the United States of America (USA).…”

“…[ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] The quality of all studies was good according to the NIH quality assessment tool [Table 1]. These studies were conducted in different parts of the world: five were conducted in India, [ 1 , 16 , 17 , 20 , 21 ] three in Turkey, [ 13 , 14 , 18 ] one in Italy, [ 15 ] and one in the United States of America (USA). [ 19 ] Most of the studies were case series; thus, the level of evidence in these studies was 4.…”

“…[ 18 , 19 , 20 , 21 ] However, two other studies have stated otherwise. [ 13 , 14 ] Özsaygili et al have reported that the prevalence of stage 4B was significantly higher than that of stage 4A (63.8% vs 43.7%, P = 0.037) in patients with a GA of 28 weeks and in those with a BW of 1000 gr (51.1% vs 35.1%, P = 0.049). However, plus diseases were significantly higher in stage 4A eyes than in stage 4B eyes (66.2% vs 48.9%, P = 0.045).…”

Vitrectomy Results for Stages 4 and 5 Retinopathy of Prematurity in Iraq

“… 9 Another study done by Özdek et al, in Turkey, studied 70 eyes of babies with ROP whom underwent consecutive PPV, and reported success rates of 95.7% for stage 4a, 83.3% for stage 4b, and 50% for stage 5 (from a total of six eyes). 14 Another Turkish study done by Karacorlu et al reported a success rate of 89% for stage 4a, 63% for stage 4b, and 42% for stage 5. 15 Shah et al, in India, studied 20 eyes with ROP that underwent LSV, and reported a success rate of 100% for stage 4a and 89% for stage 4b.…”

“…18 Özdek et al reported postoperative complications in the form of cataract (2.8%), iatrogenic retinal break (1.4%), vitreous hemorrhage (11.4%), glaucoma (10%), esotropia (34%), nystagmus (20%), and phthisis bulbi (4.3%). 14 One of the factors that might govern the postoperative complication rate is premedication with intravitreal anti VEGF, supporting that was a study done by Xu et al (2013) comparing between outcomes of PPV with and without intravitreal anti-VEGF premedication, and they reported that only the PPV group exhibited a significantly higher occurrence of preretinal hemorrhage (40%) when compared to the bevacizumab+PPV group, and some complication occurred only in the former group, including; Other complications in the control group included reproliferating of the fibrovascular tissues (two eyes), cataract (two eye), vitreous hemorrhage (two eyes), and glaucoma (one eye), and two eyes received lens surgery because of dense cataracts (13%). 19 The causes of the re-detachment may be attributed to proliferative vitreoretinopathy, reopening of a previously treated break, or developing a new break (spontaneous or iatrogenic during vitrectomy), 20 timing might help in identifying the cause, earlier re-detachments are more likely to be duo to new/re-opening of breaks, while late ones are attributed to peripheral vitreal traction.…”