Evaluation of effect and influence factors of vitrectomy for advanced retinopathy of prematurity

Abstract

Objective To observe the clinical effects of vitrectomy for advanced retinopathy of prematurity (ROP) and evaluate influence factors of anatomical recovery for stage 5 ROP.Methods Fiftyeight eyes of 40 infants with advanced ROP who underwent vitrectomy were retrospectively analyzed.There were 16 eyes of stage 4a,7 eyes of stage 4b,and 35 eyes of stage 5 ROP.Eighteen eyes received laser photocoagulation,2 eyes received cryotherapy,and 11 eyes received intravitreous injection of Bevacizumab (IVB) before surgery.The average follow-up time was 17.01 months.Anatomical outcome of retina after surgery was recorded by indirect ophthalmoscope and RetCam Ⅱ digital camera system.Visual outcome was measured by grating acuity test(lea gratingTM),and was converted to Snellen acuity values for analysis.For those who cannot cooperate to accomplish the test,we use hand move,light perception and non-light perception to record visual outcome. Results All 16 eyes of stage 4a were anatomically recovered (100.00％).5/7 eyes of stage 4b were anatomically recovered (71.43％) and 2/7 eyes were anatomically failed(28.57％).12/35 eyes of stage 5 were anatomically recovered (34.29％); 10/35 eyes were partial anatomically recovered (28.57％); 13 eyes were anatomically failed (37.14％). Anatomical outcome of stage 4a or 4b was better than stage 5 statistically(x2 =22.55,P＜0.05).Of 16 eyes of stage 4a,3 eyes were absent for visual function test.In the rest 13 eyes of stage 4a,VA of 6 eyes (46.15％) was between 0.03 and 0.07; 5 eyes (38.46％) were hand move; 2 eyes (15.39％) were light perception.Of 7 eyes of stage 4b,2 eyes (28.57％) accomplished grating acuity test with VA of 0.008 and 0.017 respectively; 1 eye (14.29％) was hand move; 2 eyes (28.57％) were light perception; 2 eyes (28.57％) were non-light perception.Of 35 eyes of stage 5,5 eyes were absent for visual function test.In the rest 30 eyes of stage 5,VAof2 eyes (6.67％) was 0.004; 4 eyes (13.33％) were hand move; 12 eyes (40.00％) were light perception; 12 eyes (40.00％) were non-light perception.Visual outcome of stage 5 was worse than stage 4a or 4b statistically(x2=15.734,P＜0.05).There was no statistically significant relationship between anatomical outcome and birth weight,gestational weeks,age at surgery,IVB therapy,laser or cryotherapy before surgery.Conclusions Vitrectomy can effectively control the lesions progress of stage 4a ROP,and achieve partially anatomically recovery of some stage 4b/5 patients.There was no statistically significant relationship between anatomical outcome and birth weight,gestational weeks,age at surgery,IVB,laser or cryotherapy before surgery. Key words: Retinopathy of prematurity/surgery; Retinal detachment/surgery; Vitrectomy