Related Experiment Videos
Lensectomy-vitrectomy for stage V cicatricial retrolental fibroplasia
Insights
Blindness from cicatricial retrolental fibroplasia in infants is rising. Surgical intervention for advanced cicatricial retrolental fibroplasia (RLF) is ineffective, highlighting the need for preventive therapies in high-risk infants.
Area of Science:
- Ophthalmology
- Neonatal Care
- Surgical Innovation
Background:
- Retrolental fibroplasia (RLF) is a leading cause of blindness in premature infants.
- Stage V cicatricial RLF represents an advanced, irreversible stage of the disease.
- Increased survival rates of low birthweight infants contribute to a rising incidence of RLF.
Observation:
- Ten infants with stage V cicatricial RLF were studied.
- Surgical interventions including lensectomy-vitrectomies and pars plana vitrectomies were performed on 12 eyes.
- Seven eyes were not operated, with five showing stage V RLF and two stable at stage II RLF.
Findings:
- All surgical attempts to reattach retinas failed.
- The Eifrig-Merritt sign indicated imminent surgical failure.
- Post-operative complications included vitreous hemorrhages, glaucoma, and phthisis bulbi in some cases.
Implications:
- Surgical visual rehabilitation is not feasible once cicatricial RLF has formed.
- Identifying and addressing early perinatal risk factors is crucial for prevention.
- Preventive therapies targeting high-risk populations are essential to reduce RLF-related blindness.
Abstract:
Ten infants (18 eyes) blind from stage V cicatricial retrolental fibroplasia were examined from January 1978 to January 1981 at North Carolina Memorial Hospital. The early perinatal factors which may have predisposed to the binding end-stage cicatrix are identified. To increase their visual potential and to prevent secondary angle closure glaucoma, 12 lensectomy-vitrectomies were performed on 12 eyes (eight infants). One eye (one infant) had a pars plana vitrectomy without lensectomy. Seven eyes (seven infants) were not operated. Five of these eyes (five infants) had stage VRLF while two eyes (two infants) remained stable at stage II RLF. All retinas remained detached immediately after surgery. Secondary vitrectomies with air injections (three eyes, two infants) similarly failed to attach any retinas. Adherence of ciliary epithelium to clear lens and retrolental membrane as visualized within the dilated pupil (Eifrig-Merritt sign) was an intra-operative indicator of imminent surgical failure. Two eyes (two infants) developed early vitreous hemorrhages, hyphemas, secondary glaucoma, and phthisis bulbi within 12 months. Follow-up data were unavailable on two infants. Blindness secondary to cicatricial retrolental fibroplasia is increasing due to increased survival of low birthweight premature infants. Since surgical visual rehabilitation is not possible after the retrolental cicatrix has formed, the risk factors common to this high risk population should prompt preventive therapies.