Anatomic and Visual Results of Surgery for Stage 5 Retinopathy of Prematurity

Abstract

Abstract: : Purpose: To assess the outcomes of surgery, particularly vitrectomy, for infants with stage 5 retinopathy of prematurity (ROP). Methods: We retrospectively reviewed the charts of 600 infants with stage 5 ROP (ICROP) in at least one eye who were referred for surgery between 1977 and 2002. Following surgery, the anatomic status and visual acuity of each eye were assessed and recorded at follow-up visits. We categorized anatomic outcome as success (fovea attached/stage 4A or foveal detachment but stage 4B) or failure (total retinal detachment/stage 5, opaque cornea, secluded pupil, or phthisis). Univariable and multivariable logistic regression were used to explore relationships between final anatomic outcomes and gestational age, birth weight, gender, age at surgery, and stage 5 ROP of the fellow eye. Predictors of relapse to stage 5 from a post-surgical outcome of stage 4A or 4B were assessed similarly. Results: The mean gestational age at birth was 26.1 weeks (SD 2.5) and the mean birthweight was 874 grams (SD 284). There were 355 infants who received surgery in both eyes, and 245 in one eye. Of the 955 eyes that underwent surgery, 21% had a history of cryotherapy and/or laser photocoagulation treatment. Vitrectomy was the main surgical approach for 96% of the eyes. The median age at surgery and median follow-up time were 39 weeks and 30 months, respectively. Of the 597 eyes with a recorded final anatomic outcome, 33.8% were a "success" and 66.2% were a "failure." Univariable odds ratios (OR) for anatomic failure were: fellow eye involved, OR=2.3 (95% CI: 1.5-3.3), history of cryotherapy, OR=2.1 (95% CI: 1.2-3.6), and history of laser photocoagulation, OR=1.0 (95% CI: 0.5-2.0). Trends suggest infants of lighter birthweight and younger gestational age were more likely to have poor anatomic outcomes. Analyses of eyes that relapsed and multivariable models revealed similar results. Of the 181 eyes with a recorded final visual acuity, 4 had 20/200 or better, 4 had 20/200 to 5/200, 18 could detect hand movement, 108 had light perception, and 47 had no light perception. Conclusions: Surgery can improve the anatomic status of retinas for approximately one third of infants with stage 5 ROP. However, initially successfully attached retinas can detach. Stage 5 ROP of the fellow eye and a history of cryotherapy may be associated with disease severity and a poor outcome. Visual acuity data is limited, but suggests that a minority of eyes (8 of 181) achieve vision better than 5/200.

Keywords: retinopathy of prematurity • vitreoretinal surgery • clinical (human) or epidemiologic studies: out