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What are the long-term outcomes of vitrectomy for advanced ROP?丨WOC 2022

Posting time:2023-01-31 14:11:48

What are the long-term outcomes of vitrectomy for advanced ROP?丨WOC 2022

Editor's note Retinopathy of prematurity (ROP) is a retinal proliferative disorder that occurs in premature and low birth weight infants and is the leading cause of childhood blindness. About 7% of ROP patients require treatment, including laser photocoagulation, anti-vascular endothelial growth Factor (VEGF) injection, vitreoretinal surgery, etc. The development of ROP is divided into five stages. When the development of traction retinal detachment occurs in stages 4 and 5, surgical intervention is required, and most people choose to undergo vitrectomy. So what are the long-term outcomes of vitrectomy for advanced ROP? Dr. Wei-chi Wu from Chang Gung Memorial Hospital shared his research results. OBJECTIVES: Patients with ROP present difficulties in the management and evaluation of patients with delayed development, potential complications, ocular complications, and recurrent retinal detachment. We conducted this study because we wanted to know whether patients with ROP after vitrectomy surgery were effectively controlled and whether the patients achieved good vision. Research Methods This study was a retrospective study. The patients were all advanced ROP (stages 4A, 4B, and 5), and the surgical intervention of vitrectomy was less than 2 years. The study began in 2005 through 2016, and patients were followed for at least 5 years. Patients were followed up regularly every 6 months, and various imaging tools such as fundus photography, OCT, and B-ultrasound were used to evaluate various clinical features. Main outcomes included retinal reattachment rate for anatomy and best corrected visual acuity for visual acuity. Secondary observations were refractive errors, ocular complications, and predictors of outcome. The study included 81 eyes of 51 patients, of which 27 eyes were stage 4A, 22 eyes were stage 4B, and 32 eyes were stage 5 (Figure 1). Stage 5 eyes were further divided into stages A, B, and C, and the mean follow-up time was 10.2 years (5-14.6 years). Figure 1. Overview of patient groupings. Results of the study From the demographic data of the patients, there were no significant differences in baseline age, gender, and birth weight between the groups (Figure 2), but there were significant differences in previous surgical history. Stage 5 ROP patients There were higher rates of laser photocoagulation, multiple vitrectomy, and scleral buckling (Figure 3). Figure 2. No significant differences in patients’ baseline age, sex, birth weight, etc. Figure 3. Patients with stage 5 ROP had higher rates of laser photocoagulation, multiple vitrectomy, and scleral buckling in terms of anatomy,69 Posterior pole attachment in % of patients and panretinal attachment in 64.2%. Anatomical reduction success rates varied among the 3 groups, with success rates as high as 96% in group 4A, 90% in group 4B, and 31% in stage 5 (Figure 4). Figure 4. Anatomical reduction results In terms of visual acuity, it can be seen that the patients with stage 4A have good visual results, followed by stage 4B, but the visual results of patients with stage 5 are poor, 88.9% of them have only no light perception, light perception and Manual visual acuity (Figure 5). Figure 5. Poor vision in stage 5 patients. Both stage 4A and 4B patients had high levels of myopia and astigmatism (Figure 6). In terms of ocular complications, the most common are cataracts and corneal opacities, which can also cause glaucoma. The incidence of cataracts was similar in stage 4A, 4B, and 5 patients, and the incidence of corneal opacity was significantly higher in stage 5 patients. In terms of predictors, stage 5 was seen to be the most important risk factor for complications (Figure 7). Figure 6. Refractive Error Results Figure 7. Summary of Predictive Factors Results Dr. Wei-chi Wu finally concluded that other literatures have previously reported high short-term (<5 years) anatomical reduction success rates for advanced ROP, but long-term (>5 years) The success rate of anatomical reduction is reduced, but the long-term results of anatomical reduction in stage 4 patients in this study are still good. Stage 5 is a decisive factor that will lead to poor outcomes. In this study, the success rate of anatomical reduction was only 25-50%, and the patients with poor treatment effect were mostly stage 5B and 5C. Many factors may affect visual outcome, including anatomical reduction success rate, refractive error, and cognitive function. There was no clear evidence that prior anti-VEGF therapy and laser photocoagulation had an effect on the patient's surgical outcome. Subscribe to search "International Ophthalmology News" or "iophthal" to view more exciting content (Source: "International Eye News" editorial department) Copyright statement Copyright belongs to "International Eye News". Personal forwarding and sharing are welcome. If any other media or website needs to reprint or quote the copyrighted content of this website, it must obtain the consent of this website and indicate at the top of the article "Reprinted from "International Ophthalmology News""

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