Dr. SIMAR RAJAN SINGH

Dr. DEEKSHA KATOCH, DR. RAMANDEEP SINGH, Dr. MANGAT R. DOGRA

Semifinals

Abstract

Forty-four eyes (31 infants) with stage 4 ROP that underwent 27-gauge lens sparing vitrectomy (LSV) between September 2019-September 2020 were included. 27 eyes (61.4%) had stage 4A ROP, TVL was present in 2 (4.5%), majority (18) had 3 – 6 clock hours of FVP, 42 eyes had laser prior to surgery. Anti VEGF was given pre-operatively in 7 eyes (15.9%) and 11 (25%) had received it as primary treatment. The mean vitrectomy time was 18.25 minutes. Sutures were required in 13 eyes (29.5%). Favorable anatomical outcome was obtained in 73.17% eyes at a mean follow up of 8.4 months. Factors contributing to unfavorable outcome were gestational age <28 week (p=0.024), laser done elsewhere (p=0.041), ectropion uveae (p=0.017) and stage 4B ROP (p=0.004). Complications encountered were intra-operative lens touch (2 eyes), post-operative loose blood (13 eyes, all of these had no prior anti-VEGF injection), cataract (3 eyes), glaucoma (2 eyes) and posterior hyaloid contracture (3 eyes).

Full Text  

27-Gauge Lens Sparing Vitrectomy for Stage 4 Retinopathy of Prematurity

Introduction

Lens sparing vitrectomy (LSV) is the standard of care for management of stage 4 Retinopathy of Prematurity (ROP). With the advent of 27-gauge instrumentation, the advantages of smaller incision size, precise dissection and sutureless closure can potentially be transferred to eyes with ROP. We report the safety and efficacy of 27-gauge LSV in management of stage 4 ROP.

Material and Methods

This was a retrospective, non-comparative, interventional case series. The study was approved by the institute ethics committee and adhered to the tenets of the declaration of Helsinki. All eyes with stage 4 ROP that underwent 27-gauge LSV between September 2019 to September 2020 were included. Pre-operative characteristics like tunica vasculosa lentis, vascular activity, extent of fibrovascular proliferation (FVP) were noted from a pre-designed performa and RetCam images. Intra-operative events like lens touch, bleeding, retinal breaks, and operative time were also noted. Successful anatomical outcome was defined as re-attachment of the posterior pole at 3-months following surgery.

Results

Forty-four eyes of 31 infants underwent 27-gauge LSV. Mean post menstrual age at the time of surgery was 42.23 weeks. Of the infants who had both eyes operated, 10 had simultaneous bilateral surgery while 3 underwent surgery on separate days. 27 eyes had stage 4A ROP while the remaining 17 had stage 4B ROP. Majority of the eyes (18) had 3 – 6 clock hours of FVP. 42 eyes had laser prior to surgery. Anti VEGF was given pre-operatively in 7 eyes and 11 eyes had received it during the prior treatment of ROP. Vascularly active ROP was seen in 8 eyes. The mean vitrectomy time was 18.25 minutes while the mean entry and closure times were 5.38 and 5.43 minutes respectively. Sutures were required in 13 eyes. Out of 41 eyes with a minimum follow up of 3 months, favorable anatomical outcome was obtained in 30 eyes (73.17%) at a mean follow up of 8.4 months. Complications encountered were intra-operative lens touch (2 eyes), post-operative loose blood (13 eyes), cataract (3 eyes), glaucoma (2 eyes) and posterior hyaloid contracture (3 eyes).

Conclusion

27-gauge LSV appears safe and effective in the management of stage 4 ROP.