Rajan Renu P, Kannan Naresh Babu, Sen Sagnik, C Lavanya, Jena Soumya, Kumar Karthik, Vijayalakshmi P, Ramasamy Kim
Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, India.
Department of Pediatric Ophthalmology, Aravind Eye Hospital, Madurai, India.
Graefes Arch Clin Exp Ophthalmol. 2021 Jul;259(7):1695-1701. doi: 10.1007/s00417-020-05063-2. Epub 2021 Jan 6.
Stage 5 retinopathy of prematurity is a difficult condition to treat despite technological advances in vitreous surgery.
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.
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.
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.
尽管玻璃体手术技术取得了进展，但早产儿视网膜病变5期仍是一种难以治疗的病症。
对2016年12月至2018年12月期间所有连续的5期ROP病例进行回顾性病历审查，纳入21例婴儿，采用改良玻璃体切除术技术评估手术效果。从文件中提取的数据包括人口统计学、ROP筛查状态、术前预防性治疗、临床表现、所进行的手术以及术后结果。
21例婴儿中，42.9%接受了眼科医生筛查。平均出生体重为1185±222.4克，平均胎龄为29.86±2.0周，平均月经后年龄为44.55±9.82周。16.7%的眼睛可见低于5期的疾病，并相应进行了处理。70%的婴儿患有双侧疾病。21只眼睛采用改良技术进行了25G经睫状体扁平部玻璃体切除术。平均随访6.33±2.18个月后，最终黄斑附着率为19%。视网膜脱离的前后封闭型结构预后较差。23.8%的眼睛实现了固定和随访视力，而57.1%的眼睛有光感。
5期ROP的治疗主要是手术治疗；然而，无论是否进行手术，最终视力不佳或视力丧失的风险都很高。本研究中描述的带有间隔物的改良手术技术可能有助于更好地操作玻璃体内的器械。
