Lens Clarity Excellent With Vitrectomy in Early Retinopathy

Pam Harrison

August 28, 2013

TORONTO, Ontario — Lens-sparing vitrectomy to correct early degrees of retinal detachment results in excellent lens clarity and vision in the majority of infants with retinopathy of prematurity, according to the largest reported case series in the world.

Success rates for retinal reattachment with a single surgery were approximately 89% for infants with stage 4A retinopathy, in which retinal detachment has started to occur, but the detachment has spared the macula. For those with stage 4B retinopathy, when retinal detachment involves the macula, success rates were 60%.

Single lens-sparing vitrectomy was less successful in infants with stage 5 retinopathy, when total retinal detachment has occurred. In these patients, an 18% success rate was reported by Michael Trese, MD, chief of pediatric and adult vitreoretinal diseases and surgery at the William Beaumont Hospital in Royal Oak, Michigan.

He presented the results here at the 31st Annual Meeting of the American Society of Retina Specialists.

"Like other tissues in the body, the retina needs blood vessels. When infants are born prematurely, there is not enough time for those blood vessels to form," he told Medscape Medical News. "If you use laser treatment to destroy the avascular peripheral retina, you can reduce the incidence of retinal detachment from about 45% to about 10%. Then, if the infant has developed an early retinal detachment, you can do a lens-sparing vitrectomy, where you leave the lens in place and improve the infant's chances of having good vision."

There are incredibly good results across the board.

For this retrospective review, investigators looked at the long-term outcomes of 220 eyes (158 patients) treated with lens-sparing vitrectomy. They used the patient's most recent office visit or an exam performed under anesthesia to evaluate lens clarity. They used reattachment rates and the need for additional retinal surgeries to determine surgical success.

At a mean follow-up of 3.2 years, "visually significant cataract formation was seen in 3 of 220 eyes (1.4%) after lens-sparing vitrectomy," Dr. Trese reported. Forty nine eyes (22.3%) also required lensectomy, primarily because the retinal detachment had worsened.

Additional retinal surgeries were required in 11% of eyes with stage 4A retinopathy, in 40% with stage 4B retinopathy, and in 82% with stage 5 retinopathy. Drops to control intraocular pressure were required in 42 eyes (19%).

"Success is clearly much better in stage 4A than in either stage 4B or 5, which signifies worse retinal detachment," Dr. Trese explained. "The trick is to get to the eyes early, which can be accomplished by doing early photographic screening, starting at about 31 weeks postmenstrual age."

Most premature infants are born at a postmenstrual age of less than 31 weeks, he added.

"There are incredibly good results across the board," said Michael Jumper, MD, from the West Coast Retinal Medical Group in San Francisco, California, who was asked by Medscape Medical News to comment on the study. "They have the biggest series in the world on retinopathy of prematurity and they set the benchmark for how to perform this surgery."

Dr. Trese and Dr. Jumper report having received honoraria from a number of pharmaceutical companies, but none are relevant to this particular study.

31st Annual Meeting of the American Society of Retina Specialists. Presented August 26, 2013.


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