Abstract
Purpose::
To determine the anatomic and visual success rate of eyes operated for stage 5 retinopathy of prematurity, either primarily or following previous surgery with or without iatrogenic retinal breaks using autologous plasmin enzyme as an adjunt to vitreous surgery reoperation.
Methods::
80 eyes were subdivided into four categories: Group 1 - Previous Vitreous Surgery without Retinal Break; Group 2 - Previous Vitreous Surgery with Retinal Break; Group 3 -eyes having Peripheral Ablation or Scleral Buckling Surgery; and Group 4 - Eyes with No Previous Treatment. All of the eyes underwent surgical therapy utilizing autologous plasmin enzyme. All patients underwent surgery from 1995 to 2004 by two surgeons (MTT , AC) and were felt to have light perception vision preoperatively by clinical examination or VEP testing.
Results::
Group 1 (38 eyes) showed an attachment rate of 78.9%; Group 2 (15 eyes) showed an attachment rate of 53.3%; Group 3 (20 eyes) showed an attachment rate of 65%; and Group 4 (7 eyes) showed an attachment rate of 57%. 70% of eyes in all four groups achieved light perception vision or better with 7.5% of eyes achieving pattern vision recognition.
Conclusions::
Plasmin enzyme-assisted vitreous surgery allows retinal reattachment in many eyes with or without previous vitreous surgery manipulation even if a retinal break was present preoperatively. Interestingly, children who had no previous treatment tended to have the worst visual response. This maybe due to the exposure of the photreceptors and retinal pigment epithelium to the blood in the subretinal space which constitutes the bulk of the subretinal fluid in retinopathy of prematurity.Children who had previous peripheral ablation with or without vitreous surgery and with or without a retinal break tended to have the best visual results. Eyes with laser peripheral ablation reduce the blood in the subretinal space and may reduce the damage to retinal elements. Previously eyes with retinal breaks during vitreous surgery have been felt to be unable to be reattached. This maybe do to the more complete PVD induced by the use of plasmin enzyme. These results suggest that it is reasonable to consider reoperation in eyes that have failed previous vitreous surgery for stage 5 retinopathy of prematurity.
Keywords: retinopathy of prematurity • retinal detachment