Successful surgical management of retinopathy of prematurity showing rapid progression despite extensive retinal photocoagulation

Gadkari, Salil S; Kulkarni, Sucheta; Kamdar, R.; Deshpande, Madan

doi:10.4103/0974-9233.159778

Cited by 4 publications

(4 citation statements)

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“…4 ]. [ 13 ] Further treatment of already adequately treated peripheral retina is unlikely to favorably affect the outcome in these cases and can in fact increase the chances of its adverse effects. The progression is fueled by ischemic tissue at the posterior pole along with residual levels of vascular endothelial growth factor (VEGF) present till the laser ablation takes full effect.…”

Section: Discussionmentioning

confidence: 99%

Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy

Gadkari

Deshpande

2017

Indian J Ophthalmol

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Purpose:We sought to document the difference in the vitreoretinal configuration of Stage 4 retinopathy of prematurity (ROP) in photocoagulated and treatment naive eyes undergoing vitrectomy and to correlate it with surgical complexity.Methods:Consecutive eyes posted for vitrectomy with Stage 4 ROP were documented preoperatively using a RetCam for the presence of peripheral traction (PT), presence of central traction just outside the arcades, and presence of traction extending to the lens. A note was made of the following intraoperative events: lensectomy, intraoperative bleeding, and iatrogenic breaks. Wilcoxon rank-sum test was used for analysis.Results:From a total of 46 eyes, 16 and 30 eyes were from the treated and treatment naive group, respectively. More eyes in the treated group had central (P < 0.0001) and lenticular traction (P = 0.022). More eyes in the untreated group had PT (P < 0.0001). A significant number of eyes without photocoagulation needed lensectomy (P = 0.042), and no difference in intraoperative bleeding (P = 0.94) was demonstrable. Iatrogenic retinotomy occurred in three eyes, all naive. Notably, age at surgery was more in the untreated group (P = 0.00008).Conclusion:Vasoproliferative activity in all retinopathies occurs at the junction of the ischemic and nonischemic retina. In the natural course of ROP, this takes place peripherally, at the ridge. In photocoagulated eyes, this junction is displaced posteriorly due to peripheral ablation. Treated eyes manifested with posterior proliferative changes and were more amenable to lens-sparing vitrectomy. Naive eyes were older when they underwent surgery to relieve PT with greater chances of lensectomy and iatrogenic breaks.

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Section: Discussionmentioning

confidence: 99%

Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy

Gadkari

Deshpande

2017

Indian J Ophthalmol

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“…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).…”

Section: Vitrectomy -Structural and Visual Outcomesmentioning

confidence: 99%

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

Chan‐Ling

Gole

Quinn

et al. 2018

Progress in Retinal and Eye Research

129

107

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The population of infants at risk for retinopathy of prematurity (ROP) varies by world region; in countries with well developed neonatal intensive care services, the highest risk infants are those born at less than 28 weeks gestational age (GA) and less than 1 kg at birth, while, in regions where many aspects of neonatal intensive and ophthalmological care are not routinely available, more mature infants up to 2000 g at birth and 37 weeks GA are also at risk for severe ROP. Treatment options for both groups of patients include standard retinal laser photocoagulation or, more recently, intravitreal anti-VEGF drugs. In addition to detection and treatment of ROP, this review highlights new opportunities created by telemedicine, where screening and diagnosis of ROP in remote locations can be undertaken by non-ophthalmologists using digital fundus cameras. The ophthalmological care of the ROP infant is undertaken in the wider context of neonatal care and general wellbeing of the infant. Because of this context, this review takes a multi-disciplinary perspective with contributions from retinal vascular biologists, pediatric ophthalmologists, an epidemiologist and a neonatologist. This review highlights the latest insights regarding cellular and molecular mechanisms in the formation of the retinal vasculature in the human infant, pathogenesis of ROP, detection and treatment of severe ROP, the risks and benefits of anti-VEGF therapy, the identification of new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes.

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“…В таких ситуациях сложно принять решение о дальнейшей тактике ведения пациентов. Проведение транспупиллярной ЛКС заведомо не является патогенетически обоснованным лечением, а возможность первичной витрэктомии вызывает у офтальмологов вопросы и разногласия [11,12].…”

Section: Discussionunclassified

Prediction Model for Determination of Indications for Laser or Surgical Treatment for Aggressive Posterior Retinopathy of Prematurity at the Manifestation Stage

Терещенко¹,

Trifanenkova²,

Сидорова³

et al. 2018

Ophthalmology in Russia

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The purpose: to analyze anthropometric and diagnostic parameters in children with aggressive posterior ROP at the manifestation stage on its basis to build a predictive model, which allows to determine the indications for laser or surgical treatment.Patients and methods. The study included 111 children (190 eyes) with aggressive posterior ROP at the manifestation stage. 67 children (134 eyes) underwent transpupillary retinal laser photocoagulation (LPC) in the period from 2008 to 2013. In 46 children (82 eyes) the disease regression was archived (group 1), in 31 children (52 eyes) the progression continued (group 2), so at the second stage early lens-sparing vitrectomy was performed (2–4 weeks after LPC). In 34 children (56 eyes) primary lens-sparing vitrectomy was performed in the period from 2013 to 2017 (group 3). Anthropometric and diagnostic data for all patients were subjected to statistical analysis for building a predictive model.Results. The predictive model was based on logistic regression that determines the probability of separation of children with aggressive posterior ROP to the manifestation stage on treatment methods: transpupillary LPC or primary vitrectomy. The following parameters were selected: the diameter of the central arteries and tortuosity index (TI). All groups were joined into a single array to create the model, which allowed to differentiate the patients according to the treatment types based on the input data processing. It was obtained the equation of the logistic regression: Z = exp(55,2726 – 0,1584X – 35,3911Y) / (1 + exp(55,2726 – 0,1584X – 35,3911Y)), where Z has the value from 0 to 1.0; X value is the diameter of the central artery of the patient; Y — the value of the TI arteries of the patient. If Z < 0.5, then the patient has indications for surgical treatment, if Z > 0.5 — for laser treatment.Conclusion. The predictive model was obtained that with a probability of 96% allows to determine objectively the optimal treatment method for children with aggressive posterior ROP at the manifestation stage of the disease: transpupillary LPC or primary vitrectomy. This will increase the effectiveness of treatment of the severe and prognostically unfavourable forms of ROP. This model can be a “working” tool for ophthalmologists involved in the treatment of ROP, its introduction into the clinical practice is advisable.

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Successful surgical management of retinopathy of prematurity showing rapid progression despite extensive retinal photocoagulation

Cited by 4 publications

References 10 publications

Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy

Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy

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

Prediction Model for Determination of Indications for Laser or Surgical Treatment for Aggressive Posterior Retinopathy of Prematurity at the Manifestation Stage

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