Vitrectomy for vitreous hemorrhage in infants with retinopathy of prematurity: clinical characteristics and anatomic outcomes

Abstract

Purpose : Retinopathy of prematurity (ROP) is a sight-threatening illness due to abnormal development of retinal vasculature in premature infants. While non-clearing vitreous hemorrhage (NCVH) in ROP patients is associated with progression to late-stage disease, controversy exists regarding the management, surgical timing, and outcomes of these cases. We performed a retrospective, observational clinical study to evaluate patient characteristics, anatomical outcomes, and visual outcomes in infants with ROP who underwent pars plana vitrectomy (PPV) for NCVH.

Methods : This is a single institution, retrospective chart review of ROP infants who underwent PPV for NCVH from November 1^st, 1998 to April 30^th, 2019. Data collected included postmenstrual age (PMA) at time of NCVH diagnosis, ROP status at time of VH, previous treatments, time between diagnosis of NCVH and PPV, intraoperative findings, and anatomic outcomes.

Results : Seven eyes of 7 patients were included (table 1). Median (range) gestational age was 25.0 (23.0-27.0) weeks. Median birth weight was 652.0 grams (445.0-822.0). PMA at the time of NCVH diagnosis was 37.6 weeks (31.0-45.3). At the last preoperative visit, all eyes were noted to have attached retinas by clinical exam. The median time to PPV from diagnosis of NCVH was 37.0 days (5.0-45.0). Median post-menstrual age (PMA) at PPV was 40.8 (36.3-47.0) weeks. The overall median time from NCVH diagnosis to PPV was 37.0 days (5.0-45.0). Intraoperatively, 3 of 7 eyes (42.9%) were noted to be detached. Median time from NCVH diagnosis to PPV was 42.0 days (5.0-45.0) in eyes with retinal detachments (RD) versus 29.0 days (20.0-37.0) in eyes without RDs. Five of 7 (71.4%) eyes remained attached at the last follow up. Of the 4 eyes with documented visual acuity upon follow-up, 2 eyes exhibited fixation behavior and 2 eyes did not exhibit fixation behavior. The median follow up time was 27.0 months (1.0-152.0).

Conclusions : NCVH in ROP requiring PPV is rare. These eyes may be at higher risk for developing a RD, particularly if there is an extended duration of time between VH diagnosis and PPV. The visual prognosis for these patients remains poor despite surgical intervention.

This is a 2021 ARVO Annual Meeting abstract.

 

Table 1: Patient characteristics, retinopathy of prematurity classification, prior treatments, surgical details, anatomic outcomes, and visual outcomes by eye.