Detachment In Retinopathy Of Prematurity Research Articles

Successful management of exudative retinal detachment in retinopathy of prematurity with sub-Tenon triamcinolone acetonide ınjection following laser photocoagulation: A case report

In this case report, we describe the successful treatment of exudative retinal detachment after laser photocoagulation with sub-Tenon’s injection of triamcinolone acetonide in a premature infant with retinopathy of prematurity (ROP). A preterm infant born at 25 weeks gestation and of weight 860 g was diagnosed with zone 2 stage 3 ROP with plus disease. Laser photocoagulation was performed to treat the active disease. After laser treatment, the infant developed exudative retinal detachment. To address the exudative retinal detachment, a sub-Tenon triamcinolone acetonide injection was administered. The procedure was well tolerated, and the patient showed rapid improvement in both clinical and imaging findings.

Evolving outcomes of surgery for retinal detachment in retinopathy of prematurity: the need for a national service in the United Kingdom : An audit of surgery for acute tractional retinal detachment complicating ROP in the UK.

To audit the structural and functional outcomes of surgery for acute tractional retinal detachment due to retinopathy or prematurity between 2004 and 2014 in Oxford UK. Consecutive operations were identified from a surgical log. Clinical data including demography, perioperative data, and retinal outcomes were extracted into a spreadsheet and compared against two international data sets referenced in the method section. Nonparametric tests (Fisher's exact, and the Mann-Whitney U-tests) were used for statistical analysis with a p-value < 0.05 considered significant. Twenty-nine eyes of 19 babies underwent surgery. The mean age (SD) at final follow-up was 6.4 (3.7) years of age and comparable to the reference data sets. The mean birth weight and gestational age of babies matched the ETROP data set referenced in the method section. Anatomical success was obtained in 16/29 (55.2%) of eyes and more likely with stage 4 ROP than stage 5 disease (p < 0.05). Thirteen of 29 eyes (44.8%) obtained form vision post-operatively. All instances of macular retinal reattachment during follow up were verified with post-operative OCT. Surgery for stage 5 ROP is not worthwhile. For stage 4 ROP it yielded better visual outcomes than ETROP but registration for visual impairment was not prevented. Innovation such as endoscopic vitrectomy could yield better outcomes. Earlier detection of vitreoretinal fibrosis could result in timelier referral. A formally funded national service is needed to ring-fence resource to avoid delays in access to surgery, which has a narrow surgical window.

Primary exudative retinal detachment in stage 4b retinopathy of prematurity managed nonsurgically – A case report

Preterm baby born at 30 weeks of gestation presented at 3 weeks with zone 1 stage 3 retinopathy of prematurity (ROP) with plus disease in the right eye and zone 1 stage 4b ROP with plus disease in the left eye. We report this rare primary presentation of exudative retinal detachment in ROP in the left eye managed by concurrent laser photocoagulation and intravitreal injection anti-VEGF. ROP regressed completely in 6 weeks. The right eye was managed similarly. Stage 4b ROP usually requires surgical intervention. We report this rare presentation managed nonsurgically with good prognosis.

Kindliche Ablationes: ROP und Myopie

This article reviews the cause and treatment options for retinopathy of prematurity (ROP)-related tractional detachment and detachments in ROP residuals during childhood and early adulthood. Retinal vascularisation is incomplete after premature birth. Phase I of ROP consists of a delayed retinal vascular growth and vessel loss after premature birth resulting in hypoxia, phase II results in hypoxia-induced vascular proliferation and as a consequence to vitreoretinal traction. The anatomic and functional outcome of tractional detachment in ROP is determined by the previous treatment (e.g., laser to the avascular periphery or anti-VEGF). While the literature reports re-attachment rates > 70 % in ROP IV a, functional and anatomic outcome in the later stages is limited. ROP residuals may cause rhegmatogenous rather than tractional detachments in childhood or early adulthood. Myopia is associated with ROP and may further complicate the retinal situation and the risk for rhegmatogenous detachment. The retinal changes due to ROP warrant lifelong controls.

VITRECTOMY AFTER INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR RETINAL DETACHMENT IN RETINOPATHY OF PREMATURITY

The purpose of this study was to evaluate the feasibility of performing vitrectomies after using bevacizumab (Avastin, Genentech, South San Francisco, CA) for the management of retinal detachments in retinopathy of prematurity. Eleven eyes of 8 children with retinopathy of prematurity retinal detachment that developed despite peripheral ablation with indirect diode laser were injected with 0.625 mg bevacizumab. Injections were given through the pars plicata, and the status of the central retinal artery was checked with indirect ophthalmoscopy. A vitreoretinal surgery was scheduled for 1 week after the bevacizumab injection. All eyes underwent surgery using 25- or 23-gauge instrumentation. Demographic data, neovascular activity, and the anatomic status of the retina were evaluated. Systemic and local perioperative complications were recorded. The average gestational birth weight was 950 g, and the average gestational age at birth was 25.7 weeks. Although 9 eyes had stage 4A, 2 had stage 4B retinal detachments. Six eyes had zone II and five eyes had zone I disease. Bevacizumab was injected at an average postgestational age of 38 weeks. A notable reduction in the vascular activity could be observed 1 week later when vitrectomy was performed. With a mean follow-up of 8.5 months (range, 2-13 months), a favorable outcome could be observed in all eyes. Only one eye with persistent vitreous hemorrhage required reoperation. No complications attributable to the bevacizumab injections were noted. These data show that vitrectomy after intravitreal bevacizumab can be effective in selected cases. The regression of the vascular activity induced by this drug might contribute to better results in some of these cases. There were no apparent short-term safety concerns for intravitreal bevacizumab injections in these babies. However, additional studies are needed to define the role of bevacizumab as a possible adjuvant in the management of retinopathy of prematurity retinal detachments.

25-GAUGE LENS-SPARING VITRECTOMY FOR STAGE 4A RETINOPATHY OF PREMATURITY

To evaluate the feasibility of performing lens-sparing vitrectomies using 25-gauge instruments for the management of stage 4A retinal detachments in Retinopathy of Prematurity (ROP). 13 eyes of 10 patients with stage 4A retinal detachments underwent a lens-sparing pars plicata vitrectomy. All patients were operated using a three port transconjunctival 25-gauge sutureless technique. The sclerotomies were made 0.5 to 1.0 mm posterior to the limbus through the pars plicata. Core vitrectomy and membrane peeling were performed. A partial fluid-air exchange was used at the end of the procedure in the majority of the cases. The anatomic status of the retina was determined by ophthalmoscopy during routine follow up visits or under general anesthesia. Per-operative complications were recorded. Eight of the infants were female and two were male. The average postmenstrual age at birth was 26.4 weeks and the average postgestational age at time of surgery was 39.3 weeks (range, 33-44). Three out of the 13 eyes (23%) had zone I ROP. With a mean follow-up of 17 months (range, 4-36) 12 out of the 13 eyes (92%) achieved successful retinal reattachment. One eye developed post operative hypotony with a small choroidal detachment that resolved spontaneously. Surgical intervention with a three port 25-gauge transconjunctival sutureless vitrectomy is an effective technique to attach the retina in patients with stage 4A retinal detachment in ROP.

25-GAUGE PARS PLICATA VITRECTOMY FOR STAGE 4 AND 5 RETINOPATHY OF PREMATURITY

To describe the authors' technique and initial experience using the 25-gauge vitrectomy system for stage 4 and 5 tractional retinal detachment in retinopathy of prematurity (ROP). Consecutive patients with stage 4 or 5 ROP treated with 25-gauge vitrectomy surgery between July 2003 and May 2004 were studied retrospectively. Eyes with prior vitrectomy surgery were excluded. A modified three-port 25-gauge approach was used in which conjunctival dissection and suturing of sclerotomies was necessary. The primary outcome was anatomic success defined as retinal reattachment. Secondary outcomes were intra- and postoperative complications. Fifteen eyes in 12 infants were identified that had 25-gauge vitrectomy for stage 4 or 5 ROP: 11/15 (73%) had stage 4A; 2/15 (13%), stage 4B; and 2/15 (13%), stage 5. All 15/15 (100%) were referred with incomplete anterior laser ablation of threshold ROP. Six of 15 (40%) required lensectomy at the time of initial pars plicata vitrectomy. Seven of 15 (47%) required more than one retinal surgery for persistent retinal detachment and/or vitreous hemorrhage. Eleven of 15 (73%) eyes had documented retinal reattachment after one or more surgeries at the last follow-up. Complications included vitreous hemorrhage (2) and postoperative cataract (1). Twenty-five gauge vitrectomy is a safe and effective treatment approach for tractional retinal detachments in stage 4 and 5 ROP. Complications may be comparable to vitrectomies performed with two-port 20-gauge vitrectomy. Modifications of the 25-gauge vitrectomy system included conjunctival dissection and suturing of conjunctiva and sclerotomies at the conclusion of the case.

Late traction detachment in retinopathy of prematurity or ROP-like cases

Five cases of traction retinal detachment occurring later in life as a sequel of cicatricial retinopathy of prematurity or showing the clinical picture of retinopathy of prematurity are reported. They presented with taut membranes in vitreous cavity, causing traction retinal detachment, and often showed preretinal membranes. These membranes were collagen-rich and contained cells with glial characteristics. They seemed to be continuously produced on the surface of the retina from which they detached sometimes in multiple generations. It is likely that chronic exudation from vascular abnormalities is a stimulus for this proliferation. These cases are very similar to other vitreoretinal proliferations in association with vascular abnormalities (Coats' and von Hippel disease, exudative vitreoretinopathy).

Visual Acuity in Infants after Vitrectomy for Severe Retinopathy of Prematurity

During the course of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP), 98 infants (129 eyes) from the randomized segment of the trial developed total retinal detachment from retinopathy of prematurity (ROP) before the 1-year examination. The authors report as a case series the results of acuity card assessment of monocular grating acuity at 1 year in 53 infants (71 eyes) postvitrectomy and in 45 infants (58 eyes) who had retinal detachments but who did not undergo retinal reattachment surgery. The decision to undertake and the surgical technique used for a retinal reattachment procedure was not part of the randomized CRYO-ROP trial. Two eyes of one infant had pattern vision at the lowest measurable threshold after vitrectomy. None of the remaining eyes that had undergone vitrectomy and none of the eyes that did not undergo vitrectomy showed evidence of pattern vision. The relatively poor visual outcomes in this case series suggest that efforts are well-spent in attempting to prevent retinal detachment in ROP.

Visual Acuity in Infants after Vitrectomy for Severe Retinopathy of Prematurity

During the course of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP), 98 infants (129 eyes) from the randomized segment of the trial developed total retinal detachment from retinopathy of prematurity (ROP) before the 1-year examination. The authors report as a case series the results of acuity card assessment of monocular grating acuity at 1 year in 53 infants (71 eyes) postvitrectomy and in 45 infants (58 eyes) who had retinal detachments but who did not undergo retinal reattachment surgery. The decision to undertake and the surgical technique used for a retinal reattachment procedure was not part of the randomized CRYO-ROP trial. Two eyes of one infant had pattern vision at the lowest measurable threshold after vitrectomy. None of the remaining eyes that had undergone vitrectomy and none of the eyes that did not undergo vitrectomy showed evidence of pattern vision. The relatively poor visual outcomes in this case series suggest that efforts are well-spent in attempting to prevent retinal detachment in ROP.

Open Sky Vitrectomy for Total Retinal Detachment in Retinopathy of Prematurity

Open sky vitrectomy was performed on 23 eyes in 18 children between 4 and 35 months of age with stage V retinopathy of prematurity (ROP). Postoperatively, the retina was reattached in the posterior pole in eight eyes (34.7%). Follow-up ranged between 7 and 55 months (average, 16 months). Prognostic factors based on preoperative findings and surgical observations are analyzed.

RETINOPATHY OF PREMATURITY

Retinal detachment, as the end result of severe retinopathy of prematurity (ROP), continues to account for many cases of blindness. Vitreous surgery can result in retinal reattachment in a significant percentage of these patients. The authors report their current techniques, which are based on improved understanding of the pathoanatomy and experience with more than 100 cases of retinal detachment in ROP treated with vitreous surgery.