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R. Singh, D. Reddy, A. Barkmeier, E. Holz, P. Carvounis; Long Term Visual Outcomes of Lens-Sparing Vitrectomy for Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5225.
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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.
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.
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.
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.
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