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Anatomical and visual results of vitreoretinal surgery for stage 5 retinopathy of prematurity
Michael Cusick1, Marci K Charles, Elvira Agrón
1Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1204, USA. mxc@nei.nih.gov
Insights
Surgery for stage 5 retinopathy of prematurity (ROP) in infants achieved anatomical success in about one-third of eyes. However, visual acuity outcomes were poor, with early surgery and fellow eye involvement predicting worse results in this historical cohort.
Area of Science:
- Ophthalmology
- Neonatal care
- Surgical outcomes
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Stage 5 ROP represents severe retinal detachment, historically associated with poor surgical outcomes.
- Surgical interventions aim to reattach the retina and preserve visual function in affected infants.
Purpose of the Study:
- To assess the long-term anatomical and visual outcomes of surgical interventions for stage 5 retinopathy of prematurity (ROP) in infants.
- To provide a historical perspective on surgical success rates over a 24-year period.
- To identify predictors of surgical success and failure in this patient population.
Main Methods:
- Retrospective observational cohort study of 601 infants with stage 5 ROP undergoing surgery between 1977 and 2001.
- Review of clinical charts for demographic data and postoperative anatomical and visual acuity outcomes.
- Anatomical success defined as macula attachment; visual function assessed using standardized acuity scales.
Main Results:
- Surgical success (macula attached) was achieved in 28% of 608 eyes with follow-up data; 55% failed (total retinal detachment).
- Light perception or better visual function was achieved in 74% of eyes with available visual acuity data.
- Early postpartum age at surgery and fellow eye involvement were significant predictors of failure and poor visual outcomes.
Conclusions:
- Surgery for stage 5 ROP in infants yielded anatomical success in approximately one-third of cases, with limited visual function recovery.
- A significant proportion of initially successful surgeries resulted in redetachment.
- This historical cohort provides a benchmark for evaluating future therapeutic strategies for severe ROP.
Purpose:
To provide a historical perspective on outcomes of surgery for infants with stage 5 retinopathy of prematurity (ROP) as performed by a single surgeon over a 24-year period.
Design:
Retrospective observational cohort study.
Setting:
Clinical practice of the Charles Retina Institute.
Patients:
The 601 infants with stage 5 ROP in at least one eye who were referred for surgery between 1977 and 2001. Charts were reviewed for demographic data and postoperative anatomical and visual acuity outcomes in eyes that underwent surgery.
Main Outcome Measures:
The postoperative anatomical status of the retina and visual function were assessed after surgery. Anatomical outcome was categorized as success (macula attached), partial success (macula detached), failure (total retinal detachment), or lost eye (opaque cornea, secluded pupil, or phthisis). Visual function was classified as>20/200, 20/200-5/200, hand movement, light perception, or no light perception. Multivariable logistic regression was used to explore relationships between outcomes and baseline characteristics.
Results:
Only a minority of eyes had prior cryotherapy (15%) or laser photocoagulation (7%) therapy. The mean follow-up was 44 months for the 956 eyes treated surgically. The 608 eyes with available follow-up data were classified as follows: 28% success, 5% partial success, 55% failure, and 11% lost eye. Visual function of light perception or better was achieved in 74% of the 183 eyes with data on visual acuity. Controlling for other baseline factors, early postpartum age at the time of surgery was a statistically significant predictor of failure/lost eye (OR=2.08, 95% CI 1.09-3.97) and no light perception (OR=5.13, 95% CI 1.45-18.14). Surgery for stage 5 ROP on the fellow eye was also a predictor of failure/lost eye (OR=2.38, 95% CI 1.39-4.08).
Conclusions:
Surgery resulted in anatomical success for approximately one third of infant eyes with stage 5 ROP, and only a minority of eyes (8 of 183) achieved visual acuity better than 5/200. However, some initially successfully attached retinas redetached. Although this study is limited by follow-up and may represent a group of patients with a more vascularly active disease state due to the low proportion of patients with prior peripheral ablation, this cohort of infants provides results against which future interventions may be compared.
