Outcomes of Modified Limbal Lensectomy-Vitrectomy in Stages 4B and 5 Retinopathy of Prematurity with Extended Retrolental Fibroplasia.

To report on the anatomical and functional outcomes of a modified limbal lensectomy-vitrectomy approach for stages 4B and 5 retinopathy of prematurity (ROP) as defined in the 3 Retrospective, monocentric, consecutive case series. Infants with ROP that underwent limbal lensectomy-vitrectomy for diffuse retrolental fibroplasia. Clinical charts and Retcam photographs were reviewed. Surgical approach consisted of a limbal lensectomy-vitrectomy through peripheral iridectomies with centripetal dissection of the preretinal fibrosis. Anatomical success and visual function at last follow-up were evaluated. Multivariate logistic regression was used to explore potential prognostic factors affecting the anatomical outcome. A total of 128 eyes of 81 patients with a mean gestational age of 28.7 ± 3.0 weeks and a mean birthweight of 1244 ± 429 grams were included. Eighteen eyes (14.1%) had a stage 4B, 24 (18.8%) a stage 5B and 86 a stage 5C (67.2%). Mean age at surgery was 57.4 ± 36.3 weeks and mean postoperative follow-up was 22.7 ± 20.4 months. Only five eyes (3.9%) had prior peripheral retinal ablation. Macular reattachment was achieved in 74 eyes (57.8%). Controlling for other baseline factors, a stage 5C (versus stage 4B, OR = 6.9 [1.5 - 32.1], p = 0.01 and versus stage 5B, OR = 7.4 [1.5 - 37.1], p = 0.02), the presence of vascular activity (OR = 6.4 [2.3 - 18.1] p < 0.001), and the presence of Schlieren sign (OR = 13.0 [2.1 - 82.2]; p = 0.006) were associated with a failure of macular reattachment. Visual acuity was assessed in 92 eyes (71.9%), among which 59 eyes (64.1%) had light perception or better. Modified limbal lensectomy-vitrectomy resulted in macular reattachment in more than half of eyes with ROP-related retinal detachment and diffuse retrolental fibrosis. A stage 5C based on ICROP 3, the presence of vascular activity and a Schlieren sign were significantly associated with a failure of macular reattachment.

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