Parameters affecting postoperative success of surgery for stage 4A/4B ROP

Br J Ophthalmol. 2019 Nov;103(11):1624-1632. doi: 10.1136/bjophthalmol-2018-312922. Epub 2019 Jan 18.


Purpose: To describe the long-term anatomical and functional results of surgery for retinal detachment (RD) associated with stage 4 retinopathy of prematurity (ROP) and patient and surgery-related factors affecting postoperative success.

Design: Retrospective case series at a single tertiary referral paediatric vitreoretinal practice.

Methods: One hundred and twenty-one eyes of 82 infants (40 female/42 male) who underwent lens-sparing vitrectomy (LSV) or lensectomy with vitrectomy surgery for stage 4A and 4B ROP at Gazi University Department of Ophthalmology between 2011 and 2016 were enrolled in this study. Patient characteristics including gestational age, birth weight, gender, stage of ROP at presentation, preoperative treatment (laser, anti-vascular endothelial growth factor (VEGF) or combined), anatomical and functional outcome and complications were recorded. The effect of birth weight, gestational age, presence of plus disease, preoperative treatment status, surgically induced posterior hyaloid detachment, postoperative vitreous haemorrhage and iatrogenic retinal tear formation on anatomical and functional results was evaluated.

Results: 61.2% of the eyes were stage 4A and 38.8% were stage 4B ROP. The mean follow-up was 24.5 months. 18.2% of the eyes had no preoperative treatment. Anatomical success was 86.5% for stage 4A and 68.1% for stage 4B at the first year, 91.7% for stage 4A and 69.4% for stage 4B at the second year, and 95.8% for stage 4A and 57.9% for stage 4B at the third year. Functional success was 85.1% for stage 4A and 65.9% for stage 4B at the first year, 89.6% for stage 4A and 61.1% for stage 4B at the second year, and 87.5% for stage 4A and 57.8% for stage 4B at the third year. The mean visual acuity was 1.12±0.34 logarithm of the minimum angle of resolution (logMAR) for stage 4A and 1.34±0.32 logMAR at the 3-year follow-up duration (p>0.05). There was preoperative plus disease in 59.5% of the eyes. Subsequent retinal surgeries were required in 17.4% of the eyes. Presence of plus disease and absence of preoperative treatment, iatrogenic retinal tear formation and postoperative vitreous haemorrhage were found to have significant negative effects, while surgical induction of posterior hyaloid detachment and sparing the lens intraoperatively affected the anatomical and functional results positively.

Conclusions: Surgery for stage 4 ROP-associated RD resulted in encouraging anatomical and functional outcomes and the results are even better in eyes with preoperative (laser/anti-VEGF) treatment, LSV and surgically induced posterior hyaloid detachment.

Keywords: retinopathy of prematurity; stage 4A /4B; surgery.

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Birth Weight
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Laser Coagulation / methods
  • Lens, Crystalline / surgery
  • Male
  • Postoperative Period
  • Retinal Detachment / physiopathology
  • Retinal Detachment / surgery*
  • Retinopathy of Prematurity / classification
  • Retinopathy of Prematurity / physiopathology
  • Retinopathy of Prematurity / surgery*
  • Retrospective Studies
  • Sclerostomy / methods
  • Treatment Outcome
  • Visual Acuity / physiology
  • Vitrectomy*
  • Vitreoretinal Surgery*


  • Angiogenesis Inhibitors