Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population

Abstract

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP).

Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression.

Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6-13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4-4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98-3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4-14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09-0.5, P < 0.005).

Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

Keywords: Microincision vitrectomy surgery; Stage 4; Stage 5; retinal detachment; retinopathy of prematurity; surgical outcome; vitrectomy.

Figure 1

(a) Intraoperative image of microincision vitrectomy surgery for Stage 5 retinopathy of prematurity; opening up of the peripheral trough is seen. (b) Intraoperative image of microincision vitrectomy surgery for “falciform fold” seen in retinopathy of prematurity using a 25 G Chandelier. (c) Stage 5 retinopathy of prematurity with retrolental fibroplasia in a 4 months old child. (d) Postoperative (6 weeks) fundus image of the same child showing well attached retina with trimmed fibrovascular proliferative tissue over disc. (e) Stage 4b retinopathy of prematurity with traction at posterior pole and laser marks from prior treatment. (f) Postoperative fundus image shows well attached retina