Clinical observations of micro-incision vitrectomy surgery for retinopathy of prematurity with early intervention failure_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Cui ,  Zhang Guoming , Chen Yi , Ma Dahui , She Jieting , Tian Ruyin , Chen Miaohong , Guo Jinlian , He Honghui , Zeng Jian , Wang Jiantao

Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Key Medical Discipline, Guangdong High-level Clinical Key Discipline, Shenzhen 518040, China;

Corresponding author：

Zhang Guoming, Email: zhang-guoming@163.com

Keywords：

Retinopathy of prematurity/surgery; Retinopathy of prematurity/drug therapy; Vitrectomy; Angiogenesis inhibitors/therapeutic use

DOI：

10.3760/cma.j.cn511434-20200305-00095

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Objective To evaluate the safety and efficacy of 27G micro-incision vitrectomy surgery (MIVS) combined with intravitreal injection of ranibizumab (IVR) in the treatment of retinopathy of prematurity (ROP) with early intervention failure.Methods Retrospective case series was performed. Fourteen eyes (11 infants) with ROP who underwent 27G MIVS combined with IVR were included from March 2016 to January 2018 in Shenzhen Eye Hospital. Among them, there were 5 males with 7 eyes, 6 females with 7 eyes. The average gestational age of the infants was 28.12±0.90 weeks; the average birth weight was 1 023.64±200.96 g. Before the early clinical intervention, 1 infant (2 eyes) had ROP in zone Ⅰstage 3 with plus disease, 8 infants (10 eyes) had ROP in zone Ⅱ stage 3 with plus disease, and 2 infants had ROP in aggressive posterior ROP. Six eyes underwent laser photocoagulation, while 8 eyes received laser therapy combined with IVR. Six eyes of stage 4A ROP and 8 eyes in stage 4B. Retinal detachment was detected with a mean of 10.44±9.21 weeks. At the time of surgery, the average post-conceptional age was 48.02±8.09 weeks. All the affected eyes were treated with standard sclera with three incisions 27G MIVS. During the operation, only local vitrectomy was performed to release and clear fibroascular proliferation in the optic disc, anterior macular area and pericristal area. After surgery, 10 mg/ml of ranibizumab 0.03 ml was injected into the vitreous cavity. The average follow-up time was 23.36±8.34 months. The primary objectives were the condition of retinal reset, ROP progression control and complications.Results All patients had uneventful surgeries with an average duration of 32.86±9.35 mins. Of the 14 eyes, 12 eyes (85.71%) were controlled, 8 eyes (57.14%) had a good rearrangement of macular structure, while 4 eyes with macular traction. Two eyes had ROP progression, recurrence of retinal detachment, posterior synechia. Complicated cataract was in 1 eye. Proliferative vitreoretinopathy and retinal detachment was in 1 eye after 7 months the operation.Conclusion 27G MIVS combined with IVR is a safe and effective treatment for ROP with early clinical intervention failure.

Citation： Wang Cui, Zhang Guoming, Chen Yi, Ma Dahui, She Jieting, Tian Ruyin, Chen Miaohong, Guo Jinlian, He Honghui, Zeng Jian, Wang Jiantao. Clinical observations of micro-incision vitrectomy surgery for retinopathy of prematurity with early intervention failure. Chinese Journal of Ocular Fundus Diseases, 2020, 36(8): 590-594. doi: 10.3760/cma.j.cn511434-20200305-00095 Copy

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2.	El Rayes EN, Vinekar A, Capone A Jr. Three-year anatomic and visual outcomes after vitrectomy for stage 4B retinopathy of prematurity[J]. Retina, 2008, 28(4): 568-572. DOI: 10.1097/IAE.0b013e3181610f97.
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4.	Sen P, Jain S, Bhende P. Stage 5 retinopathy of prematurity: an update[J]. Taiwan J Ophthalmol, 2018, 8(4): 205-215. DOI: 10.4103/tjo.tjo_61_18.
5.	Dogra MR, Katoch D, Dogra M. An update on retinopathy of prematurity (ROP)[J]. Indian J Pediatr, 2017, 84(12): 930-936. DOI: 10.1007/s12098-017-2404-3.
6.	中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for screening retinopathy of premature infants in China(2014)[J]. Chin J Ophthalmol, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.
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8.	Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial[J]. Arch Ophthalmol, 2003, 121(12): 1684-1694. DOI: 10.1001/archopht.121.12.1684.
9.	Zhang GM, Yang MM, Zeng J, et al. Comparison of intravitreal injection of ranibizumab versus laser therapy for zone ii treatment-requiring retinopathy of prematurity[J]. Retina, 2017, 37(4): 710-717. DOI: 10.1097/IAE.0000000000001241.
10.	Klufas MA, Patel SN, Chan RV. Surgical management of retinopathy of prematurity[J]. Dev Ophthalmol, 2014, 54: 223-233. DOI: 10.1159/000360470.
11.	Repka MX, Tung B, Good WV, et al. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP)[J]. Arch Ophthalmol, 2006, 124(1): 24-30. DOI: 10.1001/archopht.124.1.24.
12.	黄欣, 赵培泉, 单海冬, 等. 闭合式三切口玻璃体视网膜手术治疗4期和5期早产儿视网膜病变[J]. 中华眼底病杂志, 2008, 24(1): 9-12.Huang X, Zhao PQ, Shan HD, et al. Vitrectomy with closed triple incisions for stage 4 or 5 retinopathy of prematurity[J]. Clin J Ocul Fundus Dis, 2008, 24(1): 9-12.
13.	Fierson WM, American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, et al. Screening examination of premature infants for retinopathy of prematurity[J]. Pediatrics, 2013, 131(1): 189-195. DOI: 10.1542/peds.2012-2996.
14.	Özsaygili C, Ozdek S, Ozmen MC, et al. Parameters affecting postoperative success of surgery for stage 4A/4B ROP[J]. Br J Ophthalmol, 2019, 103(11): 1624-1632. DOI: 10.1136/bjophthalmol-2018-312922.
15.	Darwish D, Chee RI, Patel SN, et al. Anti-vascular endothelial growth factor and the evolving management paradigm for retinopathy of prematurity[J]. Asia Pac J Ophthalmol (Phila), 2018, 7(3): 136-144. DOI: 10.22608/APO.201850.

1. Chan-Ling T, Gole GA, Quinn GE, et al. Pathophysiology, screening and treatment of ROP: a multi-disciplinary perspective[J]. Prog Retin Eye Res, 2018, 62: 77-119. DOI: 10.1016/j.preteyeres.2017.09.002.
2. El Rayes EN, Vinekar A, Capone A Jr. Three-year anatomic and visual outcomes after vitrectomy for stage 4B retinopathy of prematurity[J]. Retina, 2008, 28(4): 568-572. DOI: 10.1097/IAE.0b013e3181610f97.
3. Lakhanpal RR, Sun RL, Albini TA, et al. Visual outcomes after 3-port lens-sparing vitrectomy in stage 4 retinopathy of prematurity[J]. Arch Ophthalmol, 2006, 124(5): 675-679. DOI: 10.1001/archopht.124.5.675.
4. Sen P, Jain S, Bhende P. Stage 5 retinopathy of prematurity: an update[J]. Taiwan J Ophthalmol, 2018, 8(4): 205-215. DOI: 10.4103/tjo.tjo_61_18.
5. Dogra MR, Katoch D, Dogra M. An update on retinopathy of prematurity (ROP)[J]. Indian J Pediatr, 2017, 84(12): 930-936. DOI: 10.1007/s12098-017-2404-3.
6. 中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for screening retinopathy of premature infants in China(2014)[J]. Chin J Ophthalmol, 2014, 50(12): 933-935. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.017.
7. 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.
8. Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial[J]. Arch Ophthalmol, 2003, 121(12): 1684-1694. DOI: 10.1001/archopht.121.12.1684.
9. Zhang GM, Yang MM, Zeng J, et al. Comparison of intravitreal injection of ranibizumab versus laser therapy for zone ii treatment-requiring retinopathy of prematurity[J]. Retina, 2017, 37(4): 710-717. DOI: 10.1097/IAE.0000000000001241.
10. Klufas MA, Patel SN, Chan RV. Surgical management of retinopathy of prematurity[J]. Dev Ophthalmol, 2014, 54: 223-233. DOI: 10.1159/000360470.
11. Repka MX, Tung B, Good WV, et al. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP)[J]. Arch Ophthalmol, 2006, 124(1): 24-30. DOI: 10.1001/archopht.124.1.24.
12. 黄欣, 赵培泉, 单海冬, 等. 闭合式三切口玻璃体视网膜手术治疗4期和5期早产儿视网膜病变[J]. 中华眼底病杂志, 2008, 24(1): 9-12.Huang X, Zhao PQ, Shan HD, et al. Vitrectomy with closed triple incisions for stage 4 or 5 retinopathy of prematurity[J]. Clin J Ocul Fundus Dis, 2008, 24(1): 9-12.
13. Fierson WM, American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, et al. Screening examination of premature infants for retinopathy of prematurity[J]. Pediatrics, 2013, 131(1): 189-195. DOI: 10.1542/peds.2012-2996.
14. Özsaygili C, Ozdek S, Ozmen MC, et al. Parameters affecting postoperative success of surgery for stage 4A/4B ROP[J]. Br J Ophthalmol, 2019, 103(11): 1624-1632. DOI: 10.1136/bjophthalmol-2018-312922.
15. Darwish D, Chee RI, Patel SN, et al. Anti-vascular endothelial growth factor and the evolving management paradigm for retinopathy of prematurity[J]. Asia Pac J Ophthalmol (Phila), 2018, 7(3): 136-144. DOI: 10.22608/APO.201850.

Chinese Journal of Ocular Fundus Diseases

Clinical observations of micro-incision vitrectomy surgery for retinopathy of prematurity with early intervention failure

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