Early vitrectomy in the case of stage IVA retinopathy of prematurity: pro and contra

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Objective. To evaluate the effectiveness and safety of early lens-sparing vitrectomy for the treatment of the children presenting with stage IVa retinopathy of prematurity during the early and late periods after the surgical intervention. Material and methods. We analyzed the results of the early surgical intervention for vitrectomy with synechiae removal in 83children (116 eyes) at the mean age of 40.0 ± 1.8 weeks with stage IVa retinopathy of prematurity with the use of modern methods including electrophysiological techniques. Results. Stabilization of stage retinopathy of prematurity with the complete reattachment of the retina and the elimination of the vascular activity in the fundus have been achieved in 97.4% of the cases (113 eyes). Thirteen patients (15 eyes or 13.3%) turned out to have glaucoma within the first 3 months after the onset of observations. The maximum corrected visual acuity after vitrectomy in the children at the age of 4.0 ± 0.6 averaged 0.34 ± 0.07, the spherical equivalent of myopic refraction was estimated at 9.8 ± 1,5 D. The electrophysiological study has demonstrated the well apparent reduction of electrogenesis in the central portion of the retina especially in the cone cells and the bipolar nuclear cell layer despite the absence of the noticeable ophthalmological changes in the posterior pole of the fundus in the children treated by lens-sparing vitrectomy as well as in the patients presenting with stage IVa retinopathy of prematurity managed given no vitreoretinal surgery. Conclusion. Urgent vitrectomy with synechiae removal durng the acute period of stage IVa of retinopathy of prematurity is an efficacious and pathogenetically substantiated method for the stabilization of this pathology provided the surgical intervention is performed upon the appearance of the very first signs of retinal detachment. However, the increased risk of glaucoma formation after minimally invasive lens-sparing vitrectomy should be taken into consideration. Moreover, the visual acuity remains impaired due to the inhibition of maturation of the retina at stage IVa of retinopathy of prematurity both after vitrectomy with synechiae removal and in the absence of such intervention.

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About the authors

O. V Diskalenko

Leningrad Regional Children’s Clinical Hospital

Saint Petersburg, 195009, Russian Federation

Ol’ga Aleksandrovna Konikova

Leningrad Regional Children’s Clinical Hospital; Saint-Petersburg State Pediatric Medical University

Email: olgakonikova@gmail.com
Saint Petersburg, 195009, Russian Federation
doctor of Eye Microsurgery Department, Leningrad Regional Children’s Clinical Hospital, a department of ophthalmology, Saint-Petersburg State Pediatric Medical University


  1. Коникова О.А., Бржеский В.В., Федотова Е.П., Насыров Р.А. Кислород-индуцированная ретинопатия как экспериментальная модель ретинопатии недоношенных детей. Офтальмологические ведомости. 2013; (3): 37-42.
  2. Силяева Н.Ф. Патоморфология и патогенез ретинопатии недоношенных. Вестн. офтальмол. 1990; (2): 22-5.
  3. Saint-Geniez M., D’Amore P. Development and pathology of the hyaloid, choroidal and retinal vasculature. Int. J. Dev. Biol. 2004; 48: 1045-58.
  4. Дискаленко О.В., Коникова О.А., Бржеский В.В., Гайдар М.В. Анатомо-функциональные результаты ленсвитршвартэктомии, выполненной в различном возрасте детям с V стадией ретинопатии недоношенных. Рос. педиатр. офтальмол. 2014; (4): 5-9.
  5. Дискаленко О.В., Коникова О.А. Функциональные исходы IVб и V стадии ретинопатии недоношенных. Педиатр. 2013; (1): 16-21.
  6. Терещенко А.В., Белый Ю.А., Володин П.Л. Особенности диагностики и лечения задней агрессивной ретинопатии недоношенных. В кн.: Восток-Запад: Сборник научных трудов Международной конференции по офтальмохирургии. Уфа; 2010: 472-4.
  7. Скрипец П.П., Махмутов В.Ю. Опыт витреоретинального хирургического лечения детей с 4 стадией активной ретинопатии недоношенных (РН). Клинические и функциональные результаты. Российская детская офтальмология. 2013; (2): 29-33.
  8. Терещенко А.В., Белый Ю.А., Тактика витреоретинальной хирургии при ретинопатии недоношенных. Российская детская офтальмология. 2015; (3): http://www.eyepress.ru/article.aspx?18671.
  9. Wu W.C., Lai C.C., Lin R.I., Wang N.K., Chao A.N., Chen K.J. et al. Modified 23-gauge vitrectomy system for stage 4 retinopathy of prematurity. Arch. Ophthalmol. 2011; 129 (10): 1326-31.
  10. Micelli Ferrari T., Furino C., Lorusso V. et al. Three-port lenssparing vitrectomy for aggressive posterior retinopathy of prematurity: early surgery before tractional retinal detachment appearance. Eur. J. Ophthalmol. 2007; 17 (5): 785-9.
  11. Катаргина Л.А. Современные взгляды на проблему ретинопатии недоношенных. Вестн. офтальмол. 2014; (4): 23-7.
  12. Yokoi T., Yokoi T., Kobayashi Y. et al. Risk factors for recurrent fibrovascular proliferation in aggressive posterior retinopathy of prematurity after early vitreous surgery. Am. J. Ophthalmol. 2010; 150 (1): 10-5.
  13. Repka M., Tung B. et al. Outcome of еyes developing retinal detachment during the early treatment for retinopathy of prematurity study. Arch. Ophthalmol. 2011; 129 (9): 1175-9.
  14. Bhende P., Gopal L. et al. Functional and anatomical outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 retinopathy of prematurity. Indian J. Ophthalmol. 2009; 4: 267-71.
  15. Gilbert W., Quinn G., Dobson V. et al. Partial retinal detachment at 3 months after threshold retinopathy of prematurity. Long-term structural and functional outcome. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity Cooperative Group. Arch. Ophthalmol. 1996; 114 (9): 1085-91.
  16. Joshi M., Trese M., Capone A. Optical coherence tomography findings in stage 4A retinopathy of prematurity: a theory for visual variability. Ophthalmology. 2006; 113 (4): 657-60.
  17. Lakhanpal R.R., Sun R.L., Albini T.A., Coffee R., Coats D.K., Holz E.R. Visual outcomes after 3-port lens-sparing vitrectomy in stage 4 retinopathy of prematurity. Arch. Ophthalmol. 2006; 124 (5): 675-9.
  18. Prenner J.L., Capone A. Jr., Trese M.T. Visual outcomes after lens-sparing vitrectomy for stage 4A retinopathy of prematurity. Ophthalmology. 2004; 111: 2271-3.
  19. Зерцалова М.А., Бржеский В.В., Дискаленко О.В., Гайдар М.В. Особенности клинического течения глаукомы у детей, родившихся на разных сроках гестации. Клиническая офтальмология. 2011; 12 (2): 53-5.
  20. Катаргина Л.А., Коголева Л.В., Белова М.В., Мамакаева И.Р. Клинические исходы и факторы, ведущие к нарушению зрения у детей с рубцовой и регрессивной ретинопатией недоношенных. Клиническая офтальмология. 2009; 10 (3): 3-6.
  21. Трояновский Р.Л., Синявский О.А., Солонина С.Н., и др. Ретинопатия недоношенных: профилактика и лечение отслоек сетчатки в отдаленный период. В кн.: Ретинопатия недоношенных 2013: Сборник трудов научно-практической конференции с международным участием. М.; 2013: 213-6.
  22. Iwahashi-Shima C., Miki A., Hamasaki T., Otori Y., Matsushita K., Kiuchi Y. et al. Intraocular pressure elevation is a delayed-onset complication after successful vitrectomy for stages 4 and 5 retinopathy of prematurity. Retina. 2012; 32 (8): 1636-42.



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