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25-Gauge pars plicata vitrectomy for stage 4 and 5 retinopathy of prematurity
Christine R Gonzales1, Julie Boshra, Steven D Schwartz
1The Jules Stein Eye Institute, Department of Ophthalmology, University of California at Los Angeles, David Geffen School of Medicine, California 90095, USA. Gonzales@jsei.ucla.edu
Insights
This study shows that 25-gauge vitrectomy is a safe and effective method for treating severe retinopathy of prematurity (ROP) with retinal detachment. The technique achieved retinal reattachment in most cases with manageable complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Retinal Diseases
Background:
- Retinopathy of prematurity (ROP) can lead to severe tractional retinal detachment.
- Advanced stages (4 and 5) require surgical intervention.
Purpose of the Study:
- To detail the technique and report initial outcomes of 25-gauge vitrectomy for stage 4 and 5 ROP.
- To evaluate the safety and efficacy of this minimally invasive approach.
Main Methods:
- Retrospective study of 15 eyes with stage 4 or 5 ROP treated with 25-gauge vitrectomy.
- Modified three-port technique involving conjunctival dissection and sclerotomy suturing.
- Primary outcome: anatomic success (retinal reattachment).
Main Results:
- Anatomic success (retinal reattachment) was achieved in 73% of eyes after one or more surgeries.
- 40% of eyes required lensectomy, and 47% needed repeat surgery.
- Complications included vitreous hemorrhage and postoperative cataract.
Conclusions:
- 25-gauge vitrectomy is a safe and effective treatment for advanced ROP with tractional retinal detachment.
- Outcomes and complications appear comparable to traditional 20-gauge vitrectomy.
- Surgical modifications included conjunctival and sclerotomy management.
Purpose:
To describe the authors' technique and initial experience using the 25-gauge vitrectomy system for stage 4 and 5 tractional retinal detachment in retinopathy of prematurity (ROP).
Methods:
Consecutive patients with stage 4 or 5 ROP treated with 25-gauge vitrectomy surgery between July 2003 and May 2004 were studied retrospectively. Eyes with prior vitrectomy surgery were excluded. A modified three-port 25-gauge approach was used in which conjunctival dissection and suturing of sclerotomies was necessary. The primary outcome was anatomic success defined as retinal reattachment. Secondary outcomes were intra- and postoperative complications.
Results:
Fifteen eyes in 12 infants were identified that had 25-gauge vitrectomy for stage 4 or 5 ROP: 11/15 (73%) had stage 4A; 2/15 (13%), stage 4B; and 2/15 (13%), stage 5. All 15/15 (100%) were referred with incomplete anterior laser ablation of threshold ROP. Six of 15 (40%) required lensectomy at the time of initial pars plicata vitrectomy. Seven of 15 (47%) required more than one retinal surgery for persistent retinal detachment and/or vitreous hemorrhage. Eleven of 15 (73%) eyes had documented retinal reattachment after one or more surgeries at the last follow-up. Complications included vitreous hemorrhage (2) and postoperative cataract (1).
Conclusions:
Twenty-five gauge vitrectomy is a safe and effective treatment approach for tractional retinal detachments in stage 4 and 5 ROP. Complications may be comparable to vitrectomies performed with two-port 20-gauge vitrectomy. Modifications of the 25-gauge vitrectomy system included conjunctival dissection and suturing of conjunctiva and sclerotomies at the conclusion of the case.
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