Retrolental fibroplasia: a five-year experience in a tertiary perinatal center

During a five-year period, 565 premature infants in a tertiary perinatal center were evaluated by binocular indirect ophthalmoscopy. One-hundred-ten infants had retinopathy of prematurity. Ten of these infants developed grade 5 cicatricial retrolental fibroplasia, whereas two fellow eyes remained stable at grade 2 retrolental fibroplasia. Surgical lensectomy and vitrectomy failed to improve vision or reattach the retina in any of those with grade 5 retrolental fibroplasia. In three operated eyes and two unoperated eyes secondary glaucomas developed. Five vitrectomized eyes are now known to have phthisis. The factors that modulate the transition from the benign, acute retinopathy of prematurity lesions to cicatrizing (scarring) lesions characteristic of retrolental fibroplasia remain unclear. Birth weight (less than 1000 g), multiple apneic episodes with concomitant ventilatory assistance with 100% oxygen, and inadvertent hyperoxemia during general anesthesia may be significant cicatrization factors.