Korean J Ophthalmol.  2012 Aug;26(4):277-284. 10.3341/kjo.2012.26.4.277.

Long-term Results of Lens-sparing Vitrectomy for Progressive Posterior-type Stage 4A Retinopathy of Prematurity

• Choi J
• Kim JH
• Kim SJ
• Yu YS

• KMID: 1387395
• DOI: http://doi.org/10.3341/kjo.2012.26.4.277

Abstract

PURPOSE
To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP).
METHODS
In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed.
RESULTS
Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common.
CONCLUSIONS
The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.

Keyword

Lens-sparing vitrectomy; Plus disease; Posterior; Retinopathy of prematurity; Stage 4A

MeSH Terms

Disease Progression
Female
Humans
Infant
Infant, Newborn
Male
Postoperative Complications/epidemiology
Retinal Detachment/epidemiology
Retinopathy of Prematurity/*surgery
Retrospective Studies
Treatment Outcome
Visual Acuity
Vitrectomy/*methods

Figure

• 

  Fig. 1 Fundus photographs of case 10 before and after lens-sparing vitrectomy. (A,B) Fundus photographs obtained before surgery show extraretinal fibrovascular proliferation and tractional retinal detachment of the nasal and temporal retina at posterior zone II with vitreous hemorrhage. (C) Fundus photographs obtained at 40 months after surgery show recurrence of tractional retinal detachment with fibrovascular proliferation. This case underwent additional vitrectomy and lensectomy, but lensectomy resulted in failure.

• 

  Fig. 2 Fundus photographs of case 11 before and after lens-sparing vitrectomy. (A,B) Fundus photographs obtained before surgery show extraretinal fibrovascular proliferation at nasal and temporal retina and tractional retinal detachment of nasal retina at zone I. (C) Fundus photographs obtained at 7 months after surgery show total tractional retinal detachment. This case underwent lensectomy due to secondary pupillary-block glaucoma.

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