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Surgeon: Advantages of bilateral sequential vitrectomy outweigh disadvantages in stage 4 or 5 ROP

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SAN FRANCISCO — Immediate bilateral sequential vitrectomy for retinopathy of prematurity should be considered when infants are at risk for rapid progression in both eyes, according to a speaker here.

“Performing the surgeries in the same session bilaterally or at different anesthesia sessions is an issue for these babies, so we have to weigh the advantages and the disadvantages,” Sengul Ozdek, MD, said at the American Society of Retina Specialists annual meeting.

Sengul Ozdek, MD

ROP is a bilateral disease and the surgery is usually urgent, she said, with preterm infants usually having multiple life-threatening comorbidities. In these patients, general anesthesia has a high risk, and repeated anesthesia in a short interval may have an even higher risk.

“Immediate sequential bilateral vitrectomy reduces anesthesia-related complications by at least 50% by doing just one surgery at the same session,” she said.

However, there is concern for postoperative bilateral endophthalmitis.

Ozdek and colleagues at Gazi University, Ankara, Turkey, conducted a retrospective review of 22 consecutive cases of immediate sequential bilateral surgery for stage 4 or 5 ROP to assess outcomes in these patients. Almost 45% of the cases had plus disease at the preoperative assessment.

“Surprising that we saw postoperative vitreous hemorrhage almost in 41% of the eyes,” Ozdek said, adding that the overall surgical success rate was 84%. Three eyes had glaucoma, and there were no retinal breaks, no cases of endophthalmitis and no anesthesia-related complications.

The risk for endophthalmitis in adults who undergo vitreoretinal surgery is known at 0.03%, “but the bilateral endophthalmitis risk is even much less than that,” she said. “And postponing surgery for 1 to 2 weeks leads to progression of the disease in ROP cases.” – by Patricia Nale, ELS

Reference:

Ozdek S. Bilateral simultaneous vitrectomy in stage 4-5 ROP. Presented at: American Society of Retina Specialists annual meeting; Aug. 9-14, 2016; San Francisco.

Disclosure: Ozdek reports she is a consultant for Allergan, Bayer and Novartis.