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N. Kasaoka, T. Hirose; Open-Sky Vitrectomy in Stage 5 Retinopathy of Prematurity With or Without Compromised Anterior Segments. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3137.
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To study the anatomic results of open-sky vitrectomy (OSV) in stage 5 retinopathy of prematurity (ROP) with or without compromised anterior segments.
Between January 1991 and December 2005, 310 eyes of 227 preterm infants with stage 5 ROP underwent OSV with or without additional surgery. The preoperative findings recorded were corneal clarity, extensive posterior synechiae, small fixed pupil, pupillary membranes, lens clarity, retrolental fibrous membranes, and configuration of the retinal detachment. Binocular indirect ophthalmoscopy, ultrasonography, and operating microscopy were performed while the infants were under general anesthesia before OSV.
The mean gestational age and weight at birth were 26.5 weeks and 971.7 gm, respectively, and the mean age at OSV being 12.5 months. The retinal detachments were the open-open type (20 eyes, anatomic reattachment, 50.0%), the open-closed type (138 eyes, anatomic reattachment, 47.1%), and the closed-closed type (146 eyes, anatomic reattachment, 32.9%). In six eyes, the preoperative ultrasonography could not determine the shape of the retinal detachment. There was a significant difference (chi-square test of independence l × m contingency table, p=0.034) among the three types in the rate of retinal reattachment. The anterior segments were compromised by a cloudy central cornea (37 eyes), extensive posterior synechiae (151 eyes), small fixed pupil (82 eyes), pupillary membranes (116 eyes), and lens opacity (30 eyes); 261 eyes had at least one of these findings. We tentatively referred to these eyes as having combined stage 5 with compromised anterior segments stage 6 ROP. Of 222 eyes with invisible fundi before OSV, 84 eyes (37.8%) had a reattached retina after OSV; of 81 eyes with visible fundi before OSV, 39 eyes (48.1%) had retinal reattachment after OSV. In seven eyes, the preoperative visibility of the fundus was partial. The overall success in reattaching the retina was 40.6% (126/310) after OSV.
OSV was performed in 310 eyes with stage 5 ROP; 261/310 (84.2%) had compromised anterior segments and 49/310 (15.8%) had no abnormality in the anterior segments. We referred to the former as stage 6 ROP. OSV helped reattached the retina in these eyes in which closed vitrectomy would be technically difficult or nearly impossible.
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