Influence of laser versus lens-sparing vitrectomy on myopia in children with retinopathy of prematurity

Abstract

Purpose:The purpose of this study is to compare the refractive error outcomes in the eyes of premature babies with retinopathy of prematurity (ROP) who underwent laser plus lens-sparing vitrectomy (LSV) in one eye and laser alone in the fellow eye.Methods:This is a retrospective study. Fourteen babies with Stage 4A of ROP or worse who underwent laser plus LSV in one eye (Group 1) and laser alone in the fellow eye (Group 2) were followed at 2 months, 6 months, 1 year, one and a half year, and 2 years. The main outcome variable studied was cycloplegic refraction at the baseline and follow-up visits. The change in spherical and cylindrical power at each visit was compared in Groups 1 and 2. The changes in spherical equivalent in subgroups were analyzed.Results:Mean gestational age at birth was 29.43 ± 2.10 weeks (range 26–32 weeks). Mean chronological age at the time of surgery was 4.11 ± 3.00 months (range 2–10 months). Mean postmenstrual age was 45.86 ± 12.13 weeks (range 39–75 weeks). Mean birth weight was 1340.71 ± 361.59 g (range 860–1980 g). All the babies in both groups had progressive myopia till 2 years follow-up; laser group had less myopia than LSV group till 1 year, thereafter, there was no difference in median till 2-year follow-up. The mean ± standard deviation of spherical equivalent in LSV versus laser group was: −4.36 ± 5.52 versus −3.21 ± 4.59 at 2 months; −5.09 ± 5.82 versus −4.04 ± 4.68 at 6 months; −7.14 ± 5.36 versus −5.36 ± 5.09 at 1 year; and −7.47 ± 1.38 versus −6.41 ± 1.91 at 2 years. Spherical equivalent difference across the visits did not differ significantly between Groups 1 and Group 2 in children whose birth weight was <1500 g (P = 0.247) and those who had more than 1500 g (P = 0.748), in those with gestational age between 20 and 30 weeks (P = 0.215) compared to those >30 weeks (P = 0.602).Conclusion:No difference in the progression of myopia was noted in eyes that underwent additional LSV following laser photocoagulation in one eye and laser alone in the fellow eye.

Long-Term Visual Prognosis of Patients Following Lens-Sparing Vitrectomy for Stage 4A Retinopathy of Prematurity

“…Holtz et al reported an average refractive error of −6.78 D for nine eyes after LSV in children with an average of 3.9 years [32]. Agarkar et al reported on the changes in myopia over a period-with the average refractive errors being −4.36, −5.09, −7.14, −9.13, and −7.47 D at the ages of 2 months, 6 months, 1 year, 1.5 years, and 2 years, respectively-and found that myopia increased with age [33]. Macor et al reported an average refractive error of −11.25 D for 10 eyes after LSV in children with an average of 3.0 years [34].…”

Retinopathy of Prematurity: An emerging and evolving challenge

“…Agarkar et al . [ 11 ] compared myopia in laser-treated eyes with those which underwent LSV for Stage 4 ROP. The study reports that laser-treated eyes had lesser myopia than LSV group till year 1 and after that both the groups had no significant difference.…”