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Ping Fei, Peiquan Zhao, Haiying Jin; Staged lensectomy and posterior vitrectomy in stage 5 retinopathy of prematurity with advanced complications. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3772.
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Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Stage 5ROP with advanced complications is very difficult to handle. Whether and how we should manage the situation remain questionable. Our case series verified the safety and feasibility of the staged lensectomy and vitrectomy in stage 5ROP with advanced complications.
This study is a retrospective, interventional, consecutive case series. Twenty-two eyes of 19 patients of stage 5 ROP were included in this analysis. The mean gestational age was 30±1.22 months (range: 28-32 months), including 10 males and 9 females. The average birth weight was 1540±345.33 grams. All the patients were complicated with retrolental fibroaplasia. The patients had opaque lens with flat or disappeared anterior chamber and cornearl edema or corneal opaque which called for urgent surgery to release the complications. Ultrasound B scan confirmed the diagnosis of retinal detachment. However, regular combined lensectomy and vitrctomy were not indictated due to the invisible fundus or vascularly active retina. Staged lensectomy and posterior vitrectomy were performed in all these 22 eyes. Vitrectomy would be indicated if the corneal edema improved and the fundus was visible, and/or the eyes turned to be vascularly inactive during the follow-up after lensectomy. All these eyes were followed for at least 2 years after vitrectomy (average 5.8±1.6 yrs).
Corneal opacity disappeared or reduced in 10 eyes out of 17 eyes after lensectomy. When the fundus was visible and/or the vascularity was inactive, further posterior vitrectomy was performed. The average interval between the two surgeries was 6.2±4.2months. All the patients had nomal anterior chamber after the surgeries. Retina was partially attached in all the eyes. Visual acuity ranged from NLP to FC/30cm.
Stage 5 ROP patients with flat anterior chamber, central corneal opacity and/or vascularity active retina are very difficult to manage. Staged lensectomy and posterior vitrectomy is the procedures which can prevent further complications, such as corneal endothelium decompensation, leucoma and secondary glaucoma, and preserve some useful eyesight. The earlier the lensectomy is performed, the better the prognosis is.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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