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S. O. Koinzer, C. Bruns, A. Bunse, J. Roider; Predisposing Factors for Vitrectomy in ROP Stage IV and Surgical Outcome. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5772.
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In spite of appropriate coagulation therapy, threshold retinopathy of prematurity (ROP) may progress on to retinal detachment (stage IV). Recent publications point out that it may be successfully treated by a lens sparing vitrectomy (LSV), especially in stage IVa. We compared clinical features of all preterm infants that received coagulation therapy in our clinic with the subgroup that received lens sparing vitrectomy (LSV) later on because of ROP stage IV and report on the surgical outcome of LSV.
A retrospective chart review of all preterm infants that received coagulation therapy since January 2002 was performed. We evaluated general and ophthalmological data like birth age, birth weight, age and ROP stage at the time of coagulation therapy and compared the entire group with the subgroup that received LSV later on. For the latter, ROP stage at the time of LSV, features of surgery, surgical complications and morphological outcome were evaluated.
63 eyes of 32 children received laser coagulation therapy. 10 eyes of 8 children treated by LSV were included in the study group. The overall average gestational birth age was 25 weeks with a mean birth weight of 703 grams compared to 26 weeks and 873 grams in the study group. The mean age at primary laser treatment was 34 weeks with a mean no. of laser spots of 1859 in the study group compared to 36 weeks and 1639 laser spots for the whole group. 8 eyes received laser treatment for zone 1 ROP (1 of the study group), 2 eyes for zone 3 ROP (none of the study group) and the rest for zone 2 ROP (9 of the study group). The mean age at LSV was 40 weeks. 8 out of 10 eyes received LSV at ROP stage IV a, and one eye each at stage IV b and stage V. 5 eyes had no intraoperative complications. In 2 cases a lens touch occurred and in 5 eyes a iatrogenic retinal tear occurred. The mean follow up period was 24 weeks. Out of 5 eyes with iatrogenic retinal breaks, 1 remained stage IV b, the rest ended up with a complete retinal detachment. Out of 5 eyes without surgical complications, 2 had a fully and 1 a partly attached retina. 2 developped a complete retinal detachment.
Children that showed progressive ROP after laser treatment were not younger at birth nor did they have a lower birth weight than those where ROP regressed. However, those that finally needed LSV required laser treatment at a younger age and were treated with more laser spots. Surgical outcomes of LSV seem to improve with vitrectomy at an early stage (IV a). Removal of the anterior tractions might be a modality of a good outcome, helping to avoid iatrogenic retinal tears and still treating the tractional retinal detachment in ROP effectively.
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