Surgical management of retinopathy of prematurity.
OBJECTIVE
The surgical management of retinopathy of prematurity continues to employ a paradigm of peripheral laser followed by vitrectomy for patients who develop retinal detachment. This review addresses significant advances that have been made in our understanding of the indications, timing, techniques, and outcomes of these interventions.


RESULTS
The indications for laser are highly dependent on the diagnosis of plus disease. Recognition of plus disease is variable and subjective. Efforts are underway to develop more objective measures of plus using image analysis software. Intravitreal injection of bevacizumab is emerging as an adjunct to laser for aggressive posterior retinopathy of prematurity. Although vitrectomy for retinal detachment is effective in eyes without plus, management of eyes with retinal detachment and persistent plus continues to be a major challenge. Older children with regressed retinopathy of prematurity may suffer from vitreous hemorrhage in the absence of retinal tears, detachments, or active neovascularization.


CONCLUSIONS
Our understanding of the best indications, timing, and techniques for the surgical management of retinopathy of prematurity continues to evolve and outcomes have improved in recent years. Areas that generate significant ongoing interest and investigation include the assessment of plus disease and the use of adjuncts for aggressive posterior retinopathy of prematurity.
Hubbard
G Baker
GB
The Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA. ghubba2@emory.edu
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery; D012178:Retinopathy of Prematurity / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D012591:Scleral Buckling; D014821:Vitrectomy
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
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