Anatomical and Structural Outcomes After Vitrectomy in ROP Stage 4b and 5

Abstract

Purpose: : To evaluate anatomic and functional outcome following vitrectomy for stage 4B and 5 retinopathy of prematurity (ROP) performed by a single surgeon with a minimum follow up period of two years

Methods: : 23 infants (42 eyes: 27 inborn and 15 outborn) with ROP-related retinal detachment underwent either lens-sparing vitrectomy (LSV) or combined lensectomy and vitrectomy (LV). 10 eyes had stage 4b ROP while Stage 5 was diagnosed in 32 eyes. The mean gestational age (GA) at surgery of the inborn population was 44,1wks (range 33, 1-74, 8 wks). The mean GA of outborn babies was 56, 7 wks (range 40.0-93, 6 wks). Anatomical outcomes of all eyes, classified as favourable or unfavourable as defined from CryoROP, were assessed by means of RETCAM fundus examination at 6 months of chronological age. Reactions to light, fixing and tracking ability of 16 babies (29 eyes; mean chronological age 22, 3 months) were evaluated by experienced paediatric neurologist.

Results: : LSV was performed in 19 eyes and LV in 23 eyes. Favourable outcomes were found in 50% of total cases. In stage 4B ROP both LSV and LV shoved 80% of favourable anatomic outcomes, while in stage 5 ROP better outcomes were found after LV (LV 55.6% vs. LSV 21.4%). In 25 eyes we found a reaction to the light while 4 eyes didn’t have any reaction to the light. 16 eyes had a clear fixation, 3 eyes had an uncertain fixation, and in 10 eyes no reaction.

Conclusions: : in the literature LSV or LV are the only therapies proposed for ROP after laser failure. In our experience 50% of stage 4b/5 ROP showed anatomical retinal stabilisation and RLF prevention. Although only 5 eyes achieved light tracking ability, vitrectomy allowed to maintaine a clear light fixation at 2 years of age of 16 ROP satge 4b/5 eyes.

Keywords: retinopathy of prematurity • vitreoretinal surgery • visual acuity