Lensectomy and Vitrectomy With and Without Intravitreal Triamcinolone Acetonide for Vascularly Active Stage 5 Retinal Detachments in Retinopathy of Prematurity

Lakhanpal, Rohit R.; Fortun, Jorge A.; Chan-Kai, Brian T.; Holz, Eric R.

doi:10.1097/01.iae.0000244257.60524.89

Cited by 37 publications

(24 citation statements)

References 22 publications

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“…In a recent study [53] with poor anatomical outcomes, 78% of patients had no prior peripheral ablation, likely causing the limited success rates. The use of intravitreal triamcinolone in vascularly active stage 5 ROP has been reported to increase success rates to 60% [54 ]. Considering that vision restoration technologies may be available during the lifetime of infants born today, it seems reasonable to pursue light perception vision through surgical intervention.…”

Section: Retinopathy Of Prematurity-related Retinal Detachmentmentioning

confidence: 98%

Current understanding and management of retinopathy of prematurity

Quiram

Capone

2007

Current Opinion in Ophthalmology

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Section: Retinopathy Of Prematurity-related Retinal Detachmentmentioning

confidence: 98%

Current understanding and management of retinopathy of prematurity

Quiram

Capone

2007

Current Opinion in Ophthalmology

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“…We achieved good success in stage 4b cases which was better than our previously published results where the success rate was only 44.4% [4]; however, the numbers are small in the present study. Lakhanpal et al [5] used TA at the end of vascularly active stage 5 ROP surgery to reduce postoperative inflammation and reproliferation. We excluded stage 5 ROP from our series as most of these cases present late with no prior screening or laser treatment.…”

Section: Commentmentioning

confidence: 99%

Triamcinolone acetonide-assisted vitrectomy for stage 4 retinopathy of prematurity

Shah

Narendran

2011

Int Ophthalmol

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Primary vitrectomy is the preferred surgery over sclera buckle for management of stage 4 retinopathy of prematurity (ROP) because of improved instrumentation [1] and because it directly addresses the transvitreal traction. However, inducing a posterior vitreous detachment is almost impossible in these infants as the vitreous is a transparent thick gel and tightly adherent to the retina. Thus, surgical success in stage 4 ROP depends mainly on delaminating the posterior hyaloid as much as possible, thereby relieving the traction forces without creating an iatrogenic break. To view the vitreous during vitrectomy, triamcinolone acetonide (TA) has been used for adults [2,3]. We report our experience of TA-assisted vitrectomy for stage 4 ROP. Report of casesWe carried out a retrospective review of four eyes with stage 4 ROP where we used TA as an adjunct for vitrectomy. Institutional review board approval was obtained and informed consent was taken from the parents. One eye had stage 4a ROP while three eyes had stage 4b ROP. Mean gestational age and birth weight were 27.3 weeks and 996 g, respectively. All except one with stage 4a ROP underwent additional lensectomy as traction was extending to the lens. The sclerotomies were made 1-1.5 mm from the limbus. Lens was spared in one case. After initial core vitrectomy, 0.03 ml of preservative-free TA was injected (Aurocort, Aurolab, Madurai, India). The excess drug was then washed out with active suction. The suspended particles adhered to the remaining vitreous gel and provided excellent contrast against the fundus. Because of this excellent contrast, in all cases, a posterior hyaloid detachment was induced partially in a well-ontrolled fashion without creating an iatrogenic break, either using a sharp pick (Video 1) or active suction (Video 2). Restaining with TA can be performed to confirm the removal of the posterior hyaloid.At mean follow-up of 13.5 months, the anatomical success rate was good for all four cases. The stage 4a case had normal anatomy of posterior pole and the stage 4b cases had disc dragging and residual posterior tractional retinal detachment; no glaucoma could be seen. The case with lens-sparing vitrectomy did not develop a cataract.Electronic supplementary material The online version of this article (

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“…Perioperative use of intravitreal steroids to promote vascular regression and improve surgical outcomes in advanced ROP, particularly in stage 5 eyes, has been investigated [63,64]. One series reported use of 2.0 mg/0.5 ml of intravitreal triancinolone at the end of surgery on 10 vascularly active eyes with stage 5 ROP and found the anatomic success rate to be 60% [49], which is superior to success rates of 28% or lower in other large series of stage 5 eyes [24,[65][66][67] or equivalent to results in other series [68].…”

Section: Steroidsmentioning

confidence: 99%

Surgical Management of Retinopathy of Prematurity

Klufas

Patel

Chan

2014

Microincision Vitrectomy Surgery

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The surgical treatment and management of retinopathy of prematurity (ROP) has evolved significantly over the last decade. The introduction of new techniques, instrumentation, and surgical adjuvants has added to the repertoire of options vitreoretinal surgeons have to treat complex surgical ROP cases. This chapter focuses on a review of the clinical outcomes, indications, techniques, and adjuncts for the surgical treatment of ROP.

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Lensectomy and Vitrectomy With and Without Intravitreal Triamcinolone Acetonide for Vascularly Active Stage 5 Retinal Detachments in Retinopathy of Prematurity

Abstract: Vascularly active stage 5 ROP detachments portend a poor progress. The use of TA as a postoperative adjunct may improve the likelihood of retinal reattachment in select cases.

Cited by 37 publications

References 22 publications

Current understanding and management of retinopathy of prematurity

Current understanding and management of retinopathy of prematurity

Triamcinolone acetonide-assisted vitrectomy for stage 4 retinopathy of prematurity

Surgical Management of Retinopathy of Prematurity

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