Vitreoretinal surgery for advanced retinopathy of prematurity: Presentation and outcomes from a developing country

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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“…Hence, patients coming to us with Stage 4 ROP had larger numbers of those who were untreated as compared to the treated ones. [ 11 ]…”

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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“…[ 1 ] Notably, a lot of babies in our country presenting with ROP needing surgery are larger. [ 2 ] Hence, the location of proliferation should probably have naturally been less central than that observed in our study. Therefore, we feel convinced about the location of the neovascularization/ridge as described in our article.…”

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confidence: 48%

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

Gadkari

Deshpande

2018

Indian J Ophthalmol

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“…The anatomical success rate in our cases was 95.7% for stage 4A, 83.3% for stage 4B, and 50% for stage 5 eyes, similar to previous reports. 11 , 12 , 14 , 31 , 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

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

Özdek¹,

Özmen²,

Yalınbaş³

et al. 2021

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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.

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Vitreoretinal surgery for advanced retinopathy of prematurity: Presentation and outcomes from a developing country

Cited by 17 publications

References 21 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

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

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

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