Risk Factors for Reoperation in Vitrectomy for Stage 4A Retinopathy of Prematurity
Masaki Fukushima1, Chiharu Iwahashi2, Tomoki Kurihara3
1Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan; Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
Purpose:
To determine risk factors for reoperation after vitrectomy for stage 4A retinopathy of prematurity (ROP).
Design:
Retrospective, comparative case series.
Participants:
The selected patients had undergone vitrectomy for stage 4A ROP with a minimum follow-up period of 6 months between 2010 and 2023.
Methods:
Data collected from patients' charts included gender, gestational age at birth (GA), birth weight (BW), stage of ROP, postmenstrual age (PMA) at vitrectomy, extent of fibrovascular membrane (FVM), preoperative fluorescein angiography, surgical procedure, and subsequent reoperation during the follow-up period.
Main Outcome Measures:
Anatomical success rate, incidence of postoperative vitreous hemorrhage (VH) and redetachment caused by reproliferation, and risk factors for reoperation to treat these postoperative complications.
Results:
We included 132 consecutive eyes (42 bilateral and 48 unilateral) of 90 patients (48 female and 42 male). The mean GA, BW, and PMA at surgery were 24.6 ± 1.6 weeks, 623.3 ± 180.3 g, and 41.6 ± 4.1 weeks, respectively. Final anatomic success was achieved in 128 eyes (97%). Reoperations were necessary because of postoperative VH in 31 eyes (23%), redetachment caused by reproliferation in 8 eyes (6%), and both VH and redetachment caused by reproliferation in 4 eyes (3%). Multivariable logistic regression analysis showed that plus disease (P = 0.007; odds ratio [OR], 3.681; 95% confidence interval [CI], 1.43-9.46) was a risk factor for reoperation due to postoperative VH, and greater extent of fibrovascular membrane (FVM) (P = 0.047: OR, 1.335; 95% CI, 1.004-1.776) and higher grade of fluorescein leakage (P = 0.033; OR, 5.675; 95% CI, 1.149-28.040) were risk factors for reoperation because of redetachment caused by reproliferation. In eyes with plus disease, anti-VEGF therapy as a preoperative adjunct significantly reduced the rate of reoperation for postoperative VH (20.0% vs. 60.7%, P = 0.002).
Conclusions:
High anatomical success rates could be achieved by vitrectomy for stage 4A ROP. However, eyes with plus disease, greater extent of FVM, or higher grade of fluorescein leakage may have an increased risk of reoperation. In addition, preoperative anti-VEGF therapy may reduce reoperations because of postoperative VH in patients with plus disease.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
