Delayed Lensectomy With Intra–Ocular Lens Implantation in Eyes With ROP Retinal Detachment

Abstract

Abstract: : Purpose: To evaluate the advantages of delayed versus early lensectomy and the suitability of IOL implantation in eyes with history of ROP stages IV or V and cataract. Methods: Retrospective review of cases managed at a pediatric retina referral center over a two–year interval with six months follow up. Results: Thirty preemies had successful lens–sparing vitrectomy to repair ROP stage IV or V retinal detachment and required secondary lensectomy during the subsequent four months. Indications for lensectomy included (1) visually significant lens opacity developing during or after the primary procedure, (2) angle closure glaucoma with pupillary block, and (3) progressive angle narrowing with corneal edema secondary to tube shunt touch. Nine of these patients were not suitable for contact lens correction due to inability of parents to manage the lens or presence of limbal pannus, band, or filtration bleb preventing good fit. In these patients, a foldable acrylic posterior chamber IOL was implanted in the ciliary sulcus with support from a small rim of retained anterior capsule; the posterior capsule, anterior vitreous, and lens cortex were thoroughly removed. In monocular patients, the IOL was chosen for a post–operative refraction of +4; in the remaining patients with a phakic and myopic second eye, the desired power was 4 diopters closer to emmetropia. Calculations were made utilizing a new protocol that employs the auto–refractor after lens removal. On follow up, one patient (11%) developed a visually significant pupillary membrane that required surgical excision, while the remaining eight eyes well tolerated the IOL. This incidence of re–proliferation was significantly lower than those associated with eyes that had lensectomy at the time of primary surgery for ROP retinal detachment (36%) in our center. Conclusions: For patients who develop cataract after successful repair of ROP retinal detachment and regression of neovascular activity, implantation of an IOL may be an appropriate measure in some eyes. Delay of lensectomy until after primary detachment repair may be associated with a lower incidence of anterior proliferation.

Keywords: cataract • retinopathy of prematurity • vitreoretinal surgery