Clinico-demographic profile and outcomes of 25-gauge vitrectomy in advanced stage 5 retinopathy of prematurity.

ABSTRACT

BACKGROUND: Stage 5 retinopathy of prematurity is a difficult condition to treat despite technological advances in vitreous surgery. METHODS: A retrospective chart review of all consecutive cases of stage 5 ROP was performed between December 2016 and December 2018, and 21 babies were included for assessment of surgical outcomes using a modified vitrectomy technique. Data extracted from documents included demography, ROP screening status, preoperative prophylactic therapy, clinical presentation, surgery performed, and postsurgical outcomes. RESULTS: Out of the 21 babies, ophthalmologist screening was done in 42.9%. Mean birth weight was 1185 ± 222.4 g with a mean gestational age of 29.86 ± 2.0 weeks and mean post-menstrual age of 44.55 ± 9.82 weeks. Lesser than stage 5 disease was seen in 16.7% of eyes and they were managed accordingly. Seventy percent of babies had bilateral disease. 21 eyes underwent 25-gauge pars plicata vitrectomy using a modified technique. After an average follow-up duration of 6.33 ± 2.18 months, the final macular attachment rate was 19%. Anteriorly closed-posteriorly closed type configuration of retinal detachments had a poorer outcome. Fix and follow visual acuity was achieved in 23.8% of eyes, while 57.1% of eyes had a perception of light. CONCLUSIONS: Management of stage 5 ROP is mostly surgical; however, the risk of ending up with a poor vision or vision loss is high, irrespective of whether surgery is performed. The modified surgical technique with a spacer described in this study may help in better manipulation of instruments inside the vitreous cavity.