Session Title: Vitreoretinal Surgery I
Session Date/Time: Thursday 26/09/2013 | 11:00-12:30
Paper Time: 11:48
Venue: Hall 3 (Level 0)
First Author: R.Troyanovskiy RUSSIA
Co Author(s): O. Sinyavskiy S. Solonina A. Baranov A. Sergienko
To discuss the efficiency of laser and surgery procedures in prevention and treatment retinal detachment (RD) of late retinopathy of prematurity (ROP) complications.
Delayed complications of ROP occur not only in patients with late, but also with early stages of disease and in masquerade cases with myopia, macular dragging, pigmentary alterations, equatorial retinal folds, rhegmatogenous, tractional and exudative RD. Awareness of unique anatomic features in these eyes are critical for surgical success.
31 patients aged 12-52 years (male-11, female-20) with age of gestation from 25 to 32 weeks and weight at birth from 900 to 2300 g were observed. In 18 patients (19 eyes) with 2-5 stages of ROP 28 different, often combined surgery procedures were performed: lensvitrectomy – 13, buckling – 15, ballooning – 2. Eight of these patients had oculus unus with visual acuity (VA) light perception in 4 cases (5 stage of ROP), hand moving in three cases (4B stage) and 0,1 in one case (4A stage). VA before procedure 0,03 – 1,0 was in 13 patients (13 eyes with ROP 2-3 a-c stages). Indications for laser and surgery were decreasing or loss of vision and, in some cases, eye-ache. Follow-up period was 0,5 - 12 years.
After surgery good anatomic results with retinal reattachment were achieved in 8 eyes. The local “dry folds’’ were noticed in 11 eyes. Improvement of vision took place in 14 eyes: from light perception before operation till hand moving after surgery in one eye, from 0,01 - 0,03 till 0.1-0,2 in 8 eyes, from 0.02-0.08 – 0.1-0.4 in 5 eyes. In two eyes the treatment was failed and in three cases functions were without change. The best anatomic and functional results were connected with laser procedures in cases with retinal tears, holes and degenerations without retinal detachment. Torpid uveitis with iris bloat and secondary glaucoma affected adversely on functional results. Hard exudates, fibrovascular membranes with hemorrhages in the posterior eye’s pole before operations in 8 patients with 3-5 stages were unfavourable in the late period.
ROP demands of active observation for the patient all his life. It’s very important to remember about patient’s birth history and masquerade diseases. Even a little decrease of accustomed vision and eye-ache may be indications for laser or surgery. Eye-ache without visible reasons we consider as a risk factor or onset of late ROP complications connected with increased vitreoretinociliary tractions. Laser or surgery procedures allow to stabilize, restore and improve visual functions. Torpid uveitis with secondary glaucoma, hard exudates are unfavourable for prognosis