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Visual outcomes after early vitreous surgery for aggressive posterior retinopathy of prematurity

Noriyuki Azuma1, Makiko Ito, Tadashi Yokoi

  • 1Department of Ophthalmology and Laboratory of Cell Biology, National Center for Child Health and Development, Tokyo, Japan.

JAMA Ophthalmology
|August 31, 2013
PubMed

Insights

Early vitreous surgery for aggressive posterior retinopathy of prematurity (AP-ROP) can improve visual acuity (VA) outcomes. Performing surgery before fibrovascular tissue reaches the vitreous base is crucial for foveal formation and better VA.

Area of Science:

  • Ophthalmology
  • Retinopathy of Prematurity
  • Surgical Interventions

Background:

  • Aggressive posterior retinopathy of prematurity (AP-ROP) is a severe form of ROP that progresses rapidly to retinal detachment.
  • Standard photocoagulation treatment is often insufficient for AP-ROP, necessitating alternative therapeutic strategies.
  • Early intervention may be key to managing neovascular activity and achieving retinal reattachment.

Purpose of the Study:

  • To evaluate the visual outcomes in eyes diagnosed with AP-ROP following early vitreous surgery.
  • To determine the impact of surgical timing and disease progression on visual acuity.

Main Methods:

  • Retrospective nonrandomized study involving patients who underwent early vitreous surgery with lensectomy for AP-ROP.
  • Visual acuity (VA) was measured using the preferential looking technique and VA charts.
  • Data collected included postoperative VA, ROP stage, extent of fibrovascular tissue (FT) growth, and laterality.

Main Results:

  • Visual acuity ranged from 20/2000 to 20/40.
  • Preoperative FT extent, not ROP stage, correlated with VA outcomes.
  • Eyes with FT not reaching the vitreous base showed better VA (20/250 to 20/40) due to postoperative foveal formation; those with FT reaching the vitreous base had poorer VA (20/2000 to 20/250) and no foveal formation.

Conclusions:

  • Early vitreous surgery appears beneficial for AP-ROP, particularly when performed before FT invasion of the vitreous base.
  • Facilitating foveal formation through timely surgery is critical for achieving good visual outcomes.
  • Further randomized trials are needed to compare photocoagulation, vitreous surgery, and anti-VEGF therapy for AP-ROP.
Abstract

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