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Advanced retinopathy of prematurity. The anatomic and visual results of vitreous surgery
J D Zilis1, E deJuan, R Machemer
1Devers Eye Institute, Portland.
Insights
Vitreous surgery for advanced retinopathy of prematurity (ROP) showed limited success in restoring vision and retinal attachment. Early surgery (≤6 months) was associated with poorer outcomes in children with stage 4 and 5 ROP.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Retinal Diseases
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Advanced stages (4 and 5) of ROP present significant surgical challenges.
- Vitreous surgery is a treatment option for severe ROP, but outcomes are variable.
Purpose of the Study:
- To review the anatomical and visual outcomes of vitreous surgery in children with stage 4 and 5 ROP.
- To analyze the impact of retinal detachment (RD) funnel configuration on surgical success.
- To evaluate the effect of age at surgery on outcomes.
Main Methods:
- Retrospective review of 140 eyes from 108 children undergoing vitreous surgery for stage 4 and 5 ROP.
- Classification of RD funnel configurations based on the International Committee on ROP guidelines.
- Analysis of anatomical attachment and final visual acuity.
Main Results:
- Macular attachment in stage 4 ROP: 64% (9/14 eyes).
- Posterior attachment in stage 5 ROP: 31% partial (38/121 eyes), 9% complete (11/121 eyes).
- Final visual acuity (fix and follow or better): 43% in stage 4 (6/14 eyes), 11% in stage 5 (13/121 eyes).
- Wide anterior and posterior funnel type showed best success (63% anatomical, 19% visual).
- Reoperation rarely improved vision (4%) but achieved reattachment in 22% (6/27 eyes).
- Surgery before 6 months of age correlated with lower success rates.
Conclusions:
- Vitreous surgery for advanced ROP (stages 4-5) offers limited anatomical and visual recovery.
- RD funnel configuration influences surgical outcomes.
- Surgical timing is critical, with poorer results observed in infants operated on at 6 months or younger.
Abstract:
The anatomic and visual results of vitreous surgery in 140 eyes of 108 children with stage 4 and 5 retinopathy of prematurity (ROP) were reviewed. Macular attachment was achieved in 9 (64%) of 14 eyes with stage 4. In stage 5 eyes, partial posterior attachment was obtained in 38 (31%) of 121 eyes and complete posterior attachment was obtained in 11 eyes (9%). Final visual acuity of fix and follow or greater occurred in 6 (43%) of 14 eyes with stage 4 and in 13 eyes (11%) with stage 5 ROP. Retinal detachment (RD) funnel configurations were classified according to the International Committee on ROP. The funnel type which was wide anteriorly and wide posteriorly had the best anatomic (63%) and visual (19%) success. Reoperation rarely improved visual acuity (4%), although reattachment was possible in 6 (22%) of 27 eyes. All children in this series underwent surgery by 2 years of age. Anatomic and visual success was achieved less often in children who underwent surgery at age 6 months or younger.
