Functional and anatomical outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 retinopathy of prematurity.
BACKGROUND
While lens-sacrificing vitrectomy is the standard approach to manage Stage 5 retinopathy of prematurity (ROP), scleral buckling has been used to manage some cases of Stage 4. Lens-sparing vitrectomy was popularized by Maguire and Trese in selected cases of Stage 4 disease.


OBJECTIVE
To assess the functional and visual outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 ROP.


METHODS
In a retrospective, interventional, consecutive case series, the records of 39 eyes of 31 patients presenting with Stage 4 retinal detachment secondary to ROP who underwent primary two or three-port lens-sparing vitrectomy from January 2000 to October 2006 were evaluated. The outcomes studied at the final follow-up visit were the retinal status, lens and medial clarity and visual acuity . Favorable anatomical outcome was defined as the retinal reattachment of the posterior pole at two months after the surgery; and favorable functional outcome was defined as a central, steady and maintained fixation, with the child following light.


RESULTS
At mean follow-up of 15 months, 74% of the eyes had a favorable anatomical outcome with single procedure. The visual status was favorable in 63% . The lens remained clear in all the eyes at the last follow-up, and the media clarity was maintained in 87%. Intraoperative complications included vitreous hemorrhage, pre-retinal hemorrhage and retinal break formation.


CONCLUSIONS
Lens-sparing vitrectomy helps to achieve a favorable anatomical and functional outcome in selected cases of Stage 4 ROP.
Bhende
Pramod
P
Sri Bhagwan Mahaveer Vitreoretinal Services, Medical and Vision Research Foundations, Sankara Nethralaya, 18 College Road, Chennai, India. pramod1999@yahoo.com
Gopal
Lingam
L
Sharma
Tarun
T
Verma
Aditya
A
Biswas
Rupak Kanti
RK
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications; D007908:Lens, Crystalline; D008297:Male; D011183:Postoperative Complications; D012178:Retinopathy of Prematurity / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014821:Vitrectomy / Q000009:adverse effects / Q000379:methods*