Abstract
Purpose: :
To compare the long term visual outcomes of lens-sparing vitrectomy (LSV) with and without scleral buckling (SB) for Stage 4A, 4B and 5 retinopathy of prematurity.
Methods: :
Infants with ROP who underwent LSV by a single surgeon at a tertiary referral center between 1998 and 2004 were included. The primary endpoint was visual acuity at least 5 years after surgical intervention. Anatomic success, defined as complete retinal attachment, was evaluated as a secondary end point. Patients who underwent lensectomy or did not have a documented visual acuity five years post operatively were excluded.
Results: :
Sixty of 124 patients with retinopathy of prematurity requiring surgical intervention for stage 4A, 4B and 5 between 1998 to 2004 underwent LSV. Follow up of at least 5 years was available for 18 eyes of 13 patients.The group that underwent LSV with SB comprised 13 eyes of 10 patients (9 Stage 4A, 3 Stage 4B, 1 Stage 5). The average length of follow up was 8.15 years, and the average logMAR visual acuity in this group was 1.176 (Snellen equivalent 20/300) for patients with measurable visual acuity. One patient with severe developmental delay was able to fix and follow in both eyes, and 2 eyes had light perception only. Only 1 eye was not attached, and the final visual acuity in this patient was NLP at 10 years of age.The group that underwent LSV without SB comprised 5 eyes or 3 patients (all with Stage 4A disease). The average length of follow up was 5.8 years, and the average logMAR visual acuity was 1.61 (Snellen equivalent 20/815) for the 4 eyes with form vision while 1 eye had light perception only. Anatomic success was noted in all 5 cases.There were no statistically significant differences in the final logMAR visual acuity (paired t-test, p = .331) or long-term anatomic attachment rates (paired t-test, p = .52) between the two groups.
Conclusions: :
Long term visual outcomes of LSV are similar with or without SB. SB should be employed without concern about adverse effect on visual outcomes in the long-term in cases that may benefit from its use. Additionally, parents may be informed that while LSV is necessary to preserve vision the resulting vision is often limited.
Keywords: retinopathy of prematurity