Therapeutic effect of segmental scleral buckling and vitreoretinal surgery for stage 4 and 5 retinopathy of prematurity_Chinese Journal of Ocular Fundus Diseases

Authors：

LiXiaochun , CaoXiaoguang , LiXiaoxin , YinHong ,  LiangJianhong

Department of Ophthalmology, Peking University People's Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100044, China;

Corresponding author：

LiangJianhong, Email: drjianhongliang@sina.com

Keywords：

Retinopathy of prematurity/surgery; Scleral buckling; Vitreoretinal surgery

DOI：

10.3760/cma.j.issn.1005-1015.2016.05.011

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Objective To observe the therapeutic effect of segmental scleral buckling and vitrectomy with/without lensectomy on the retinopathy of prematurity (ROP) stage 4a, 4b and 5. Methods One hundred and thirty-four ROP infants (181 eyes) diagnosed as stage 4a, 4b and 5, and performed with segmental scleral buckling or vitreous with/without lensectomy were retrospectively analyzed. The operated 4a-, 4b- and 5- stage eyes were 40, 51 and 90 eyes. The operational method depended on the location and severity of fibrovascular membrane. Of 181 eyes, segmental scleral buckling was referred for 37 eyes which include 23 eyes with 4a stage and 14 eyes with 4b stage; vitrectomy was referred for 50 eyes which include 14 eyes with 4a stage, 29 eyes with 4b stage and 7 eyes with 5 stage; vitrectomy with lensectomy was referred for 94 eyes which include 3 eyes with 4a stage, 8 eyes with 4b stage and 83 eyes with 5 stage. The effect was classified as success, improved and failure. Failure includes lost eye. Follow-up for 4a, 4b and 5 stage patients are 34, 31 and 29 months respectively. Results Segmental scleral buckling was referred for 37 eyes, success in 23 eyes (62.16%), improved in 11 eyes (29.73%), failure in 3 eyes (8.11%). Vitrectomy was referred for 50 eyes, and success in 20 eyes (40.00%), improved in 22 eyes (44.00%), and failure in 8 eyes (16.00%). In the total of 94 eyes underwent vitrectomy with lensectomy, 20 eyes was success (21.28%), improved in 17 eyes (18.08%), failure in 57 eyes (60.64%). In 40 stage 4a eyes, 33 successes (82.50%), 6 improved (15.00%) and 1 failure (2.50%). In 51 stage 4b eyes, 11 successes (21.57%), 30 improved (58.82%) and 10 failures (19.61%). For 90 stage 5 eyes, 14 successes (17.50%), 19 improved (23.75%) and 57 failures (71.25%). The therapeutic effect of segmental scleral buckling for stage 4a was better than that for stage 5 (χ²=6.707,P=0.035). The difference of therapeutic effect of vitrectomy for different stage was significant (χ²=21.010,P=0.000); stage 4a was the best; stage 4b was the second, stage 5 was the worst. The therapeutic effect of vitrectomy with lensectomy for stage 5 was worse than that for stage 4a and 4b (χ²=16.066,P=0.003). Conclusion The surgery patterns of ROP was determined based on the disease severity, the surgery effects of stage 4a and 4b were better than stage 5, which had nothing to do with the surgical procedures.

Citation： LiXiaochun, CaoXiaoguang, LiXiaoxin, YinHong, LiangJianhong. Therapeutic effect of segmental scleral buckling and vitreoretinal surgery for stage 4 and 5 retinopathy of prematurity. Chinese Journal of Ocular Fundus Diseases, 2016, 32(5): 505-509. doi: 10.3760/cma.j.issn.1005-1015.2016.05.011 Copy

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2.	Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:preliminary results[J]. Arch Ophthalmol, 1988, 106(4):471-479.
3.	Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:three-month outcome[J]. Arch Ophthalmol, 1990, 108(2):195-204.
4.	Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:31/2-year outcome--structure and function[J]. Arch Ophthalmol, 1993, 111(3):339-344.
5.	Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:Snellen visual acuity and structural outcome at 51/2 years after randomization[J]. Arch Ophthalmol, 1996, 114(4):417-424.
6.	Flynn JT, Bancalari E, Bachynski BN, et al. Retinopathy of prematurity:diagnosis, severity, and natural history[J]. Ophthalmology, 1987, 94(6):620-629.
7.	Sears JE, Sonnie C. Anatomic success of lens-sparing vitrectomy with and without scleral buckle for stage 4 retinopathy of prematurity[J]. Am J Ophthalmol, 2007, 143(5):810-813. DOI:10.1016/j.ajo.2007.01.017.
8.	Cusick M, Charles MK, Agron E, et al. Anatomical and visual results of vitreoretinal surgery for stage 5 retinopathy of prematurity[J]. Retina, 2006, 26(7):729-735. DOI:10.1097/01.iae.0000244268.21514.f7.
9.	International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7):991-999. DOI:10.1001/archopht.123.7.991.
10.	Trese MT. Scleral buckling for retinopathy of prematurity[J]. Ophthalmology, 1994, 101(1):23-26.
11.	Chuang YC, Yang CM. Scleral buckling for stage 4 retinopathy of prematurity[J]. Ophthalmic Surg Lasers, 2000, 31(5):374-379.
12.	Greven C, Tasman W. Scleral buckling in stages 4B and 5 retinopathy of prematurity[J]. Ophthalmology, 1990, 97(6):817-820.
13.	Hinz BJ, de Juan E Jr, Repka MX. Scleral buckling surgery for active stage 4A retinopathy of prematurity[J]. Ophthalmology, 1998, 105(10):1827-1830. DOI:10.1016/s0161-6420(98)91023-5.
14.	Capone A Jr, Trese MT. Lens-sparing vitreous surgery for tractional stage 4A retinopathy of prematurity retinal detachments[J]. Ophthalmology, 2001, 108(11):2068-2070.
15.	Hubbard GB 3rd, Cherwick DH, Burian G. Lens-sparing vitrectomy for stage 4 retinopathy of prematurity[J]. Ophthalmology, 2004, 111(12):2274-2277. DOI:10.1016/j.ophtha.2004.05.030.
16.	Lakhanpal RR, Davis GH, Sun RL, et al. Lens clarity after 3-port lens-sparing vitrectomy in stage 4A and 4B retinal detachments secondary to retinopathy of prematurity[J]. Arch Ophthalmol, 2006, 124(1):20-23. DOI:10.1001/archopht.124.1.20.
17.	Hanneken A, Baird A. Soluble forms of the high-affinity fibroblast growth factor receptor in human vitreous fluid[J]. Invest Ophthalmol Vis Sci, 1995, 36(6):1192-1196.
18.	Prenner JL, Capone A Jr, Trese MT. Visual outcomes after lens-sparing vitrectomy for stage 4A retinopathy of prematurity[J]. Ophthalmology, 2004, 111(12):2271-2273. DOI:10.1016/j.ophtha.2004.06.021.
19.	Fuchino Y, Hayashi H, Kono T, et al. Long-term follow up of visual acuity in eyes with stage 5 retinopathy of prematurity after closed vitrectomy[J]. Am J Ophthalmol, 1995, 120(3):308-316.
20.	Hirose T, Katsumi O, Mehta MC, et al. Vision in stage 5 retinopathy of prematurity after retinal reattachment by open-sky vitrectomy[J]. Arch Ophthalmol, 1993, 111(3):345-349.
21.	Quinn GE, Dobson V, Barr CC, et al. Visual acuity of eyes after vitrectomy for retinopathy of prematurity:follow-up at 51/2 years[J]. Ophthalmology, 1996, 103(4):595-600.
22.	Trese MT. Visual results and prognostic factors for vision following surgery for stage Ⅴ retinopathy of prematurity[J]. Ophthalmology, 1986, 93(5):574-579.
23.	Trese MT, Droste PJ. Long-term postoperative results of a consecutive series of stages 4 and 5 retinopathy of prematurity[J]. Ophthalmology, 1998, 105(6):992-997.

1. Steinkuller PG, Du L, Gilbert C, et al. Childhood blindness[J]. J AAPOS, 1999, 3(1):26-32.
2. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:preliminary results[J]. Arch Ophthalmol, 1988, 106(4):471-479.
3. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:three-month outcome[J]. Arch Ophthalmol, 1990, 108(2):195-204.
4. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:31/2-year outcome--structure and function[J]. Arch Ophthalmol, 1993, 111(3):339-344.
5. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity:Snellen visual acuity and structural outcome at 51/2 years after randomization[J]. Arch Ophthalmol, 1996, 114(4):417-424.
6. Flynn JT, Bancalari E, Bachynski BN, et al. Retinopathy of prematurity:diagnosis, severity, and natural history[J]. Ophthalmology, 1987, 94(6):620-629.
7. Sears JE, Sonnie C. Anatomic success of lens-sparing vitrectomy with and without scleral buckle for stage 4 retinopathy of prematurity[J]. Am J Ophthalmol, 2007, 143(5):810-813. DOI:10.1016/j.ajo.2007.01.017.
8. Cusick M, Charles MK, Agron E, et al. Anatomical and visual results of vitreoretinal surgery for stage 5 retinopathy of prematurity[J]. Retina, 2006, 26(7):729-735. DOI:10.1097/01.iae.0000244268.21514.f7.
9. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited[J]. Arch Ophthalmol, 2005, 123(7):991-999. DOI:10.1001/archopht.123.7.991.
10. Trese MT. Scleral buckling for retinopathy of prematurity[J]. Ophthalmology, 1994, 101(1):23-26.
11. Chuang YC, Yang CM. Scleral buckling for stage 4 retinopathy of prematurity[J]. Ophthalmic Surg Lasers, 2000, 31(5):374-379.
12. Greven C, Tasman W. Scleral buckling in stages 4B and 5 retinopathy of prematurity[J]. Ophthalmology, 1990, 97(6):817-820.
13. Hinz BJ, de Juan E Jr, Repka MX. Scleral buckling surgery for active stage 4A retinopathy of prematurity[J]. Ophthalmology, 1998, 105(10):1827-1830. DOI:10.1016/s0161-6420(98)91023-5.
14. Capone A Jr, Trese MT. Lens-sparing vitreous surgery for tractional stage 4A retinopathy of prematurity retinal detachments[J]. Ophthalmology, 2001, 108(11):2068-2070.
15. Hubbard GB 3rd, Cherwick DH, Burian G. Lens-sparing vitrectomy for stage 4 retinopathy of prematurity[J]. Ophthalmology, 2004, 111(12):2274-2277. DOI:10.1016/j.ophtha.2004.05.030.
16. Lakhanpal RR, Davis GH, Sun RL, et al. Lens clarity after 3-port lens-sparing vitrectomy in stage 4A and 4B retinal detachments secondary to retinopathy of prematurity[J]. Arch Ophthalmol, 2006, 124(1):20-23. DOI:10.1001/archopht.124.1.20.
17. Hanneken A, Baird A. Soluble forms of the high-affinity fibroblast growth factor receptor in human vitreous fluid[J]. Invest Ophthalmol Vis Sci, 1995, 36(6):1192-1196.
18. Prenner JL, Capone A Jr, Trese MT. Visual outcomes after lens-sparing vitrectomy for stage 4A retinopathy of prematurity[J]. Ophthalmology, 2004, 111(12):2271-2273. DOI:10.1016/j.ophtha.2004.06.021.
19. Fuchino Y, Hayashi H, Kono T, et al. Long-term follow up of visual acuity in eyes with stage 5 retinopathy of prematurity after closed vitrectomy[J]. Am J Ophthalmol, 1995, 120(3):308-316.
20. Hirose T, Katsumi O, Mehta MC, et al. Vision in stage 5 retinopathy of prematurity after retinal reattachment by open-sky vitrectomy[J]. Arch Ophthalmol, 1993, 111(3):345-349.
21. Quinn GE, Dobson V, Barr CC, et al. Visual acuity of eyes after vitrectomy for retinopathy of prematurity:follow-up at 51/2 years[J]. Ophthalmology, 1996, 103(4):595-600.
22. Trese MT. Visual results and prognostic factors for vision following surgery for stage Ⅴ retinopathy of prematurity[J]. Ophthalmology, 1986, 93(5):574-579.
23. Trese MT, Droste PJ. Long-term postoperative results of a consecutive series of stages 4 and 5 retinopathy of prematurity[J]. Ophthalmology, 1998, 105(6):992-997.

Chinese Journal of Ocular Fundus Diseases

Therapeutic effect of segmental scleral buckling and vitreoretinal surgery for stage 4 and 5 retinopathy of prematurity

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