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Subretinal hemorrhage after lens-sparing vitrectomy in infants born at or under 24 weeks gestation
M Elizabeth Hartnett1, R Jeffrey Board, Odette Houghton
1University of North Carolina, Chapel Hill, North Carolina, USA. hartnet@med.unc.edu
Insights
Very premature infants with severe retinopathy of prematurity (ROP) required early laser and lens-sparing vitrectomies (LSV). Complications like subretinal hemorrhage occurred, highlighting the need for improved therapies for extremely preterm infants.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- Rapidly progressive ROP in extremely preterm infants presents unique management challenges.
Purpose of the Study:
- To report short-term outcomes of laser therapy and lens-sparing vitrectomies (LSV) in infants with rapidly progressive ROP.
- To evaluate the safety and efficacy of early surgical intervention for severe ROP in very low gestational age infants.
Main Methods:
- Retrospective chart review of infants born at or before 24 0/7 weeks gestational age.
- Analysis of infants requiring laser treatment and subsequent LSV for severe ROP between August 2006 and January 2007.
Main Results:
- Five female infants (mean GA 23 4/7 weeks) received bilateral laser for zone 1 or posterior zone II ROP.
- Eight eyes underwent LSV for progressive stage 4 ROP at a mean postmenstrual age of 38.2 weeks.
- Subretinal hemorrhage occurred in five eyes post-LSV, with three developing fibrosis and incomplete retinal reattachment.
Conclusions:
- Rapidly progressive ROP necessitates early laser and LSV in extremely preterm infants.
- Subretinal hemorrhage and fibrosis may be linked to extensive laser use and early vitrectomy timing.
- Novel therapeutic strategies are crucial for managing ROP in very young, extremely preterm infants with large avascular retinal zones.
Purpose:
To describe short term outcomes in a case series of infants with rapidly progressive retinopathy of prematurity (ROP) requiring laser and lens-sparing vitrectomies (LSV) at early postmenstrual ages (PMAs).
Methods:
Retrospective chart review of infants born at or under 24 0/7 weeks consecutively referred for management of severe ROP between August 2006 and January 2007.
Results:
Five female infants (mean gestational age 23 4/7 weeks, mean birthweight 514.4 g) required laser treatment bilaterally for zone 1 or posterior zone II ROP at 35-37 weeks PMA. LSV was performed for progressive stage 4 ROP in eight eyes at 37-39 weeks PMA (mean 38.2 weeks). Subretinal hemorrhage occurred after LSV in five eyes, with three developing subretinal fibrosis preventing complete retinal reattachment.
Conclusion:
Premature infants in this series had rapidly progressive ROP requiring laser and LSV at early PMAs. Subretinal hemorrhage occurred and may be related to the amount of laser necessary to treat large zones of avascular retina, and the early timing of vitrectomy when postoperative contracting preretinal vitreous no longer has the natural tamponading force of formed gel against it. Improved therapies for premature infants of very young gestational ages and large avascular zones are needed.
