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Management of advanced retinopathy of prematurity in the older patient
1Department of Ophthalmology, Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, MI.
Insights
Vitreous surgery can improve vision in older patients with advanced retinopathy of prematurity (ROP) by clearing opaque membranes and revealing attached retina. Visual-evoked potentials better predicted retinal function than ultrasound in this study.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pediatric Ophthalmology
Background:
- Advanced retinopathy of prematurity (ROP) can lead to significant vision loss.
- Dense retrolenticular membranes in stage 5 ROP obscure retinal visualization and function.
- Surgical intervention is often considered for eyes with advanced ROP.
Purpose of the Study:
- To evaluate the efficacy of vitrectomy, lensectomy, and membrane peeling in older patients with stage 5 ROP.
- To compare the preoperative predictive value of visual-evoked potentials (VEPs) versus B scan ultrasound for retinal function.
- To assess visual outcomes following surgical intervention in this patient cohort.
Main Methods:
- Retrospective analysis of 11 eyes from 10 patients (age 4-33 years) with stage 5 ROP.
- All eyes underwent vitrectomy, lensectomy, and membrane peeling.
- Preoperative VEPs and B scan ultrasound were compared for predicting intraoperative findings and visual potential.
Main Results:
- Intraoperative findings revealed attached retina (stage 4B) in all studied eyes.
- Reproducible VEP waveforms were more accurate in predicting retinal configuration and function than B scan ultrasound.
- Postoperative visual improvement was observed in 7 (63.6%) eyes.
Conclusions:
- Vitreous surgery can be beneficial in selected older patients with advanced ROP by clearing media opacities.
- Surgery can uncover functional, attached retina, potentially improving usable vision.
- VEPs show promise as a superior preoperative tool for assessing retinal function in advanced ROP compared to ultrasound.
Abstract:
The authors studied 11 eyes of 10 patients who complained of a recent decrease in vision and whose eyes had the clinical appearance of stage 5 retinopathy of prematurity (ROP) as diagnosed by the presence of a dense, opaque retrolenticular membrane. Patients ranged in age from 4 to 33 years, and birth weights ranged from 680 to 1077 g. All eyes underwent vitrectomy, lensectomy, and membrane peeling and were found intraoperatively to have areas of retina that were attached (stage 4B). Preoperatively, a reproducible visual-evoked potential waveform appeared to better predict this retinal configuration and potential retinal function than did the contact B scan ultrasound of the globe. Postoperatively, seven (63.6%) eyes demonstrated an improvement in vision. Vitreous surgery may be beneficial in selected eyes of older patients with advanced ROP to clear media opacities and to uncover areas of functional, attached retina, which may allow these patients to more effectively use the vision they possess.