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K.A. Tawansy, H. Lee; PREDICTORS OF ANATOMIC FAILURE IN SURGERY FOR ADVANCED NEONATAL ROP RETINAL DETACHMENTS . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3525.
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Purpose: To evaluate ocular and systemic characteristics that represent risks for poor anatomic outcome in the setting of vitreo–retinal surgery for neonates with acute ROP retinal detachments stages IV and V. Methods: Retrospective review of clinical records of patients managed at a major pediatric retina referral center between 1996 and 2002. Results: We found 310 consecutive eyes with ROP retinal detachment that underwent vitrectomy or scleral buckle and had one year follow up data. Stable macular attachment was found to be present in 190 (61%) overall and ranged from 45% for tight funnel configurations to 90% for well–ablated dry extra–macular detachments. Causes for structural failure included 1) proliferative vitreo–retinopathy, with or without retina to retina or retina to iris adhesions in 54%, 2) significant post–operative hemorrhage in 39%, and 3) intraoperative retinal breaks in 7%. Peri–operative factors associated with a poor outcome included (1) vitrectomy in a vascularly active eye as manifest by persistent plus and active neovascularization, 2) vitrectomy before the due date, 3) lensectomy during primary vitreous surgery, and 4) delayed or missed screening leading to delayed or inadequate laser ablation. Eyes with severe persistent ischemia after laser as manifest by new neovascularization, heavy iridohyaloidal vessels, or new hemorrhage or subretinal exudates had the worst prognosis (42% final anatomic success) and were more likely to achieve macular attachment when scleral buckle was performed alone or with vitrectomy rather than vitrectomy alone as primary intervention. Conclusions: A model to predict surgical success may be designed based on local and systemic risk factors in addition to retinal configuration. Control of ischemia and delay of retinal detachment or vitrectomy surgery beyond the due date may improve success in severe cases.
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