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Vitrectomy Results for Stages 4 and 5 Retinopathy of Prematurity in Iraq
Hasan M Bahrani1, Khitam Fakhir Alhasseny2
1American Eye & Retina Center, Erbil, Iraq.
Insights
Vitrectomy outcomes in preterm infants with advanced retinopathy of prematurity (ROP) show a 64.5% success rate. This study highlights challenges and complications in surgical ROP management for Iraqi neonates.
Area of Science:
- Ophthalmology
- Neonatal Surgery
- Retinopathy of Prematurity Research
Background:
- Advanced stages (4 and 5) of retinopathy of prematurity (ROP) often necessitate surgical intervention.
- Specific surgical standards are required for ROP operations due to unique ocular characteristics in premature infants.
- Access to specialized surgical centers is crucial for effective ROP treatment.
Purpose of the Study:
- To evaluate the outcomes of vitrectomy surgery in Iraqi preterm infants diagnosed with stage 4 and 5 ROP.
- To identify risk factors associated with re-detachment in eyes that have undergone surgery for ROP.
- To document the initial surgical experience with vitrectomy for ROP in Iraqi children.
Main Methods:
- A prospective cohort study involving 19 Iraqi preterm infants (31 eyes) with stage 4 and 5 ROP.
- Surgical intervention via vitrectomy was performed between November 2020 and June 2023.
- A 9-month follow-up period assessed anatomical success (retinal attachment) and postoperative complications.
Main Results:
- The overall surgical success rate was 64.5%.
- Success rates varied by ROP stage: 90.9% for stage 4a, 57.1% for stage 4b, and 33.3% for stage 5a.
- Complications included vitreous hemorrhage (16.1%), cataract (16.1%), secondary glaucoma (22.6%), and 9.7% required a second vitrectomy.
Conclusions:
- The study demonstrates encouraging initial results for vitrectomy in managing ROP in Iraqi children.
- 19.4% of operated eyes remained complication-free at the 1-year follow-up.
- This experience provides valuable insights into the surgical management of ROP in a resource-limited setting.
Background:
Stage 4 and 5 retinopathy of prematurity (ROP) is a serious condition that may require surgical intervention at some point. Timely intervention is a key element and, with the peculiarity of eyes among this group that necessities a certain level of surgical standards, operations cannot be undertaken in any surgical eye center.
Aim Of The Study:
To recognize the outcomes of vitrectomy in Iraqi preterm babies with stage 4 and 5 ROP, and to study factors that might increase the risk of re-detachment in operated eyes.
Methods:
A prospective cohort study undertaken from November 2020 to June 2023 for Iraqi preterm babies presenting with stage 4 and 5 ROP requiring surgical intervention. Each patient had a follow-up duration of 9 months. The primary follow-up outcome was anatomical success rate (flat versus detached), and the secondary outcome was to identify the postoperative complications.
Results:
This study enrolled 19 children; 11 males and eight females (number of eyes operated on was was 31), with a mean gestational age of 29.4±2.1 weeks. There were six (19.4%) eyes that did not develop any complications, five (16.1%) eyes developed postoperative vitreous hemorrhage, five (16.1%) eyes developed cataract, three (9.7%) eyes underwent a second vitrectomy, and seven (22.6%) eyes developed secondary glaucoma. The surgical success rates were 90.9% for stage 4a, 57.1% for stage 4b, and 33.3% for stage 5a.
Conclusion:
This study presented the first surgical experience for vitrectomy in children with retinopathy of prematurity in our country, and the results were encouraging with an overall surgical success rate of 64.5%, and 19.4% of eyes did not develop any complication until the 1-year of follow-up.
