In advanced ROP, consider more laser if disease persists after treatment

Vitreous haze, neovascularization and plus disease are associated with poor surgical outcomes for patients with stage 4 and 5 retinopathy of prematurity, according to an analysis. If neovascularization and plus disease persist after initial treatment of ROP, additional laser should be considered before surgery for retinal detachment, a physician suggests.

M. Elizabeth Hartnett, MD, at the University of North Carolina, Chapel Hill, reported on 35 eyes of 22 infants who were referred with stages 4 and 5 ROP. She analyzed ocular features requiring surgical intervention that were recorded before the development of retinal detachment. Univariate and multivariate analyses were used to determine which features were associated with failure to achieve retinal reattachment as the main outcome.

Surgical procedures included scleral buckle, lensectomy-vitrectomy and lens-sparing vitrectomy.

All eyes underwent at least one surgical procedure; nine had successful reattachment after the first surgery and 18 achieved retinal reattachment at the end of follow-up.

Features significantly associated with surgical failure after the first surgery were vitreous haze, hemorrhage or organization, plus disease and neovascularization.

In stage 4 eyes, vitreous organization and plus disease were associated with failed reattachment. In stage 5 eyes, at least six clock hours of ridge elevation and plus disease were significantly associated with retinal reattachment failure. Poor surgical outcomes tended to occur more frequently with lensectomy-vitrectomy.

The study is published in Retina.