Current concepts and techniques of vitrectomy for retinopathy of prematurity

Abstract

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. ROP screening and interventions (e.g., laser ablation and anti-vascular endothelial growth factor [VEGF] therapy) at the right time can reduce disease activity and prevent retinal detachment. However, sometimes, ROP is refractory to treatment, leading to tractional retinal detachment (TRD), requiring surgical intervention, such as vitrectomy. Vitrectomy for Stage 5 ROP (total retinal detachment) is beneficial in preventing total blindness in some patients. However, it has poor anatomical and functional results. Vitrectomy (lens-sparing vitrectomy, if possible) should be performed at Stage 4A ROP (partial TRD not involving the macula) because the anatomical and functional results are much better.

Keywords: Antivascular endothelial growth factor therapy; lens-sparing vitrectomy; lensectomy; retinal detachment; retinopathy of prematurity; vitrectomy.

Figure 1

Stage 4A retinopathy of prematurity with high vascular activity after confluent laser ablation of the peripheral avascular retina the patient was born with. An anti-vascular endothelial growth factor agent (ranibizumab) was injected intravitreally

Figure 2

Two days after intravitreal injection of ranibizumab, an anti-vascular endothelial growth factor agent. Vascular tortuosity, dilatation, and injection of fibrovascular membranes are improved. Lens-sparing vitrectomy was performed

Figure 3

One year after lens-sparing vitrectomy for Stage 4A retinopathy of prematurity, the retina appears completely reattached

Figure 4

Anterior segment view of Stage 5 retinopathy of prematurity at the beginning of vitrectomy. Retrolental fibroplasia, a white membrane, and total retinal detachment are observed

Figure 5

Intraoperative view of vitrectomy for Stage 5 retinopathy of prematurity. After lensectomy, membrane peeling and delamination are performed

Figure 6

Stage 5 retinopathy of prematurity (right eye). Six days postoperatively, the retina is still detached; however, subretinal fluid is already reduced remarkably. The retina will be reattached within few weeks