Rhegmatogenous Retinal Detachment in Neonatal Retinopathy of Prematurity

Abstract

Abstract: : Purpose: To report anatomic and visual outcomes of a consecutive series of eyes that developed spontaneous or iatrogenic retinal tears during the management and evolution of acute ROP Methods: Retrospective review of charts and photographs of 15 eyes of 15 patients managed at two referral centers Results: Retinal breaks occurred in four situations: 1) complicating vitreous surgery, 2) complicating external sclerotomy, 3) at the edge of heavy laser for zone 1 disease, and 4) induced by traction (PVR) occurring post–operatively. With a minimum of 6 months follow up, stable complete anatomic re–attachment was achieved in 8 of 15 cases (53%) using a surgical paradigm that includes meticulous removal of the hyaloid from the disc to the break, extension of the break to a relaxing retinotomy, encircling buckle to support the remaining periphery, and silicone oil tamponade. Plasmin was used as adjuvant for vitreous removal in two eyes. While visual outcomes were poor and ranged from light perception to 20/800, none of the eyes with stable reattachment progressed to phthisis. Conclusions: Although eyes with active ROP and retinal breaks have been considered inoperable, a modern surgical approach may result in anatomic salvage of a significant percentage.

Keywords: retinopathy of prematurity • retinal detachment • vitreoretinal surgery