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Management of Stage 4 ROP

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Retinopathy of Prematurity

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Abstract

Successfully managing stage 4A ROP retinal detachment, that is, a partial detachment not involving the fovea, is the last opportunity of obtaining good vision in these eyes. The onset of stage 4 is thus a therapeutic window that cannot be missed. All efforts must be placed on a timely diagnosis and intervention. Performing a lens-sparing vitrectomy in eyes with stage 4 ROP results in very good anatomical and functional outcomes in the majority of the cases. The use of antiVEGF drugs prior to the vitreoretinal surgery, to induce regression of the neovascular activity, can further improve these results and allow earlier and safer interventions.

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References

  1. 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. Arch Ophthalmol.

    Google Scholar 

  2. Steinkuller PG, Du L, Gilbert C, et al. Childhood blindness. J AAPOS. 1999;3:26–32.

    Article  CAS  PubMed  Google Scholar 

  3. Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev. 2008;84(2):77–82.

    Article  PubMed  Google Scholar 

  4. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: ophthalmological outcomes at 10 years. Arch Ophthalmol. 2001;119:1110–8.

    Article  Google Scholar 

  5. Gilbert W, Quinn GE, Dobson V, et al. Partial retinal detachment at 3 months after threshold retinopathy of prematurity. Long-term structural and functional outcome. Arch Ophthalmol. 1996;114:1085–91.

    Article  CAS  PubMed  Google Scholar 

  6. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: 31/2-year outcome-structure and function. Arch Ophthalmol 1993;111:339–344.

    Google Scholar 

  7. Hu J, Blair MP, Shapiro MJ, Lichtenstein SJ, Galasso JM, Kapur R. Reactivation of retinopathy of prematurity after bevacizumab injection. Arch Ophthalmol. 2012;130(8):1000–6. Erratum in: Arch Ophthalmol. 2013;131(2):212.

    Google Scholar 

  8. Recchia FM, Capone A Jr. Contemporary understanding and management of retinopathy of prematurity. Retina. 2004;24(2):283–92.

    Article  PubMed  Google Scholar 

  9. Prenner JL, Capone A Jr, Trese MT. Visual outcomes after lens-sparing vitrectomy for stage 4A retinopathy of prematurity. Ophthalmology. 2004;111(12):2271–3.

    Article  PubMed  Google Scholar 

  10. Capone A Jr, Trese MT. Lens-sparing vitreous surgery for tractional stage 4A retinopathy of prematurity retinal detachments. Ophthalmology. 2001;108(11):2068–70.

    Article  PubMed  Google Scholar 

  11. Hubbard GB 3rd, Cherwick DH, Burian G. Lens-sparing vitrectomy for stage 4 retinopathy of prematurity. Ophthalmology. 2004;111(12):2274–7.

    Article  PubMed  Google Scholar 

  12. Moshfeghi AA, Banach MJ, Salam GA, Ferrone PJ. Lens-sparing vitrectomy for progressive tractional retinal detachments associated with stage 4A retinopathy of prematurity. Arch Ophthalmol. 2004;122(12):1816–8.

    Article  PubMed  Google Scholar 

  13. Lakhanpal R, Sun R, Albini T, Holz E. Anatomic success rate after 3-port lens-sparing vitrectomy in stage 4A or 4B retinopathy of prematurity. Ophthalmology. 2005;112:1569–73.

    Article  PubMed  Google Scholar 

  14. Lakhanpal RR, Sun RL, Albini TA, Coffee R, Coats DK, Holz ER. Visual outcomes after 3-port lens-sparing vitrectomy in stage 4 retinopathy of prematurity. Arch Ophthalmol. 2006;124(5):675–9.

    Article  PubMed  Google Scholar 

  15. Kychenthal A, Dorta P. 25-gauge lens-sparing vitrectomy for stage 4A retinopathy of prematurity. Retina. 2008;28(3 Suppl):S65–8.

    Article  PubMed  Google Scholar 

  16. Hairston RJ, Maguire AM, Vitale S, Green WR. Morphometric analysis of pars plana development in humans. Invest Ophthalmol Vis Sci. 1992;33:1197.

    Google Scholar 

  17. Lemley Craig A, Han Dennis P. An age-based method for planning sclerotomy placement during pediatric vitrectomy: a 12-year experience. Retina. 2007;27(7):974–7.

    Article  PubMed  Google Scholar 

  18. Capone A. Lens-sparing vitrectomy for posterior retinopathy of prematurity: indications and techniques. Vitreoretinal Surg Technol. 1993;5:3–4.

    Google Scholar 

  19. Ferrone PJ, Trese MT, Williams GA, Cox MS. Good visual acuity in an adult population with marked posterior segment changes secondary to retinopathy of prematurity. Retina. 1998;18(4):335–8.

    Article  CAS  PubMed  Google Scholar 

  20. Fuchino Y, Hayashi H, Kono T, Ohshima K. Long term follow-up of visual acuity in eyes with stage 5 retinopathy of prematurity after closed vitrectomy. Am J Ophthalmol. 1995;120:308–16.

    Article  CAS  PubMed  Google Scholar 

  21. Kychenthal A, Dorta P. Vitrectomy after intravitreal bevacizumab (Avastin) for retinal detachment in retinopathy of prematurity. Retina. 2010;30(4 Suppl):S32–6.

    Article  PubMed  Google Scholar 

  22. Azuma N(1), Ishikawa K, Hama Y, Hiraoka M, Suzuki Y, Nishina S. Early vitreous surgery for aggressive posterior retinopathy of prematurity. Am J Ophthalmol. 2006;142(4):636–43.

    Google Scholar 

  23. Mintz-Hittner Helen A, Kennedy Kathleen A, Chuang Alice Z. Efficacy of intravitreal bevacizumab for stage 3 + retinopathy of prematurity. N Engl J Med. 2011;364(7):603–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Travassos A, Teixeira S, Ferreira P, et al. Intravitreal bevacizumab in aggressive posterior retinopathy of prematurity. Ophthalmic Surg Lasers Imaging. 2007;38:233–7.

    PubMed  Google Scholar 

  25. Quiroz-Mercado H, Martinez-Castellanos MA, Hernandez-Rojas ML, Salazar-Teran N, Chan RV. Antiangiogenic therapy with intravitreal bevacizumab for retinopathy of prematurity. Retina. 2008;28(Suppl):S19–25.

    Article  PubMed  Google Scholar 

  26. Lalwani GA, Berrocal AM, Murray TG, et al. Off-label use of intravitreal bevacizumab (Avastin) for salvage treatment in progressive threshold retinopathy of prematurity. Retina. 2008;28(Suppl):S13–8. Retina. 2009;29:127. Erratum.

    Google Scholar 

  27. Kusaka S, Shima C, Wada K, et al. Efficacy of intravitreal injection of bevacizumab for severe retinopathy of prematurity: a pilot study. Br J Ophthalmol. 2008;92:1450–5.

    Article  CAS  PubMed  Google Scholar 

  28. Dorta P, Kychenthal A. Treatment of type 1 retinopathy of prematurity with intravitreal bevacizumab (Avastin). Retina. 2010;30(Suppl):S24–31.

    Article  PubMed  Google Scholar 

  29. Greven CM, Tasman WS. Scleral buckling in stages 4B and 5 retinopathy of prematurity. Ophthalmol: J AAO, 97(6);817–20.

    Google Scholar 

  30. Trese MT. Ophthalmology. 1994;101(1):23–6. Scleral buckling for retinopathy of prematurity.

    Google Scholar 

  31. Hinz BJ, de Juan E Jr. Repka MX Scleral buckling surgery for active stage 4A retinopathy of prematurity. Ophthalmology. 1998;105(10):1827–30.

    Article  CAS  PubMed  Google Scholar 

  32. Chuang YC, Yang CM. Scleral buckling for stage 4 retinopathy of prematurity. Ophthalmic Surg Lasers. 2000;31(5):374–9.

    Google Scholar 

  33. Hartnett ME, Maguluri S, Thompson HW, McColm JR. Comparison of retinal outcomes after scleral buckle or lens-sparing vitrectomy for stage 4 retinopathy of prematurity. Retina. 2004;24(5):753–7.

    Article  PubMed  Google Scholar 

  34. Sears JE, Sonnie C. Anatomic success of lens-sparing vitrectomy with and without scleral buckle for stage 4 retinopathy of prematurity. Am J Ophthalmol. 2007;143(5):810–3.

    Article  PubMed  Google Scholar 

  35. Trese MT, Retinopathy of prematurity. pp 189-193. Shapiro MJ, Biglan AW, Miller MT. In: Proceedings of the international conference on retinopathy of prematurity. Chicago, IL, USA: Kugler Publications; 1993. ISBN 90 6299 1254.

    Google Scholar 

  36. Chow DR, Ferrone PJ, Trese MT. Refractive changes associated with scleral buckling and division in retinopathy of prematurity. Arch Ophthalmol. 1998;116(11):1446–8.

    Article  CAS  PubMed  Google Scholar 

  37. Wiegand W, Kroll P. Retinopathy of prematurity. pp 197–199. Shapiro MJ, Biglan AW, Miller MT. In: Proceedings of the international conference on retinopathy of prematurity. Chicago, IL, USA: Kugler Publications; 1993. ISBN 90 6299 1254.

    Google Scholar 

  38. Gadkari S, Kamdar R, Kulkarni S, Deshpande M, Taras S. Vision development over an extended follow-up period in babies after successful vitrectomy for stage 4b retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol.

    Google Scholar 

  39. Singh R, Kumari N, Katoch D, Sanghi G, Gupta A, Dogra MR. Outcome of 23-gauge pars plana vitrectomy for pediatric vitreoretinal conditions. J Pediatr Ophthalmol Strabismus. 2014;51(1):27–31.

    Google Scholar 

  40. Wu WC, Lai CC, Lin RI, Wang NK, Chao AN, Chen KJ, Chen TL, Hwang YS. Modified 23-gauge vitrectomy system for stage 4 retinopathy of prematurity. Arch Ophthalmol. 2011;129(10):1326–31.

    Article  PubMed  Google Scholar 

  41. Iwahashi-Shima C, Miki A, Hamasaki T, Otori Y, Matsushita K, Kiuchi Y, Okada M, Kusaka S. Intraocular pressure elevation is a delayed-onset complication after successful vitrectomy for stages 4 and 5 retinopathy of prematurity. Retina. 2012;32(8):1636–42.

    Article  PubMed  Google Scholar 

  42. Xu Y, Zhang Q, Kang X, Zhu Y, Li J, Chen Y, Zhao P. Early vitreoretinal surgery on vascularly active stage 4 retinopathy of prematurity through the preoperative intravitreal bevacizumab injection. Acta Ophthalmol. 2013;91(4):e304–10.

    Article  CAS  PubMed  Google Scholar 

  43. Lakhanpal RR, Fortun JA, Chan-Kai B, Holz ER. Lensectomy and vitrectomy with and without intravitreal triamcinolone acetonide for vascularly active stage 5 retinal detachments in retinopathy of prematurity. Retina. 2006;26(7):736–40.

    Article  PubMed  Google Scholar 

  44. Shah PK, Narendran V, Kalpana N. Triamcinolone acetonide-assisted vitrectomy for stage 4 retinopathy of prematurity. Int Ophthalmol. 2011;31(3):237–8.

    Article  PubMed  Google Scholar 

  45. Margherio AR, Margherio RR, Hartzer M, et al. Plasmin enzyme-assisted vitrectomy in traumatic pediatric macular holes. Ophthalmology. 1998;105:1617–20.

    Article  CAS  PubMed  Google Scholar 

  46. Tsukahara Y, Honda S, Imai H, et al. Autologous plasminassisted vitrectomy for stage 5 retinopathy of prematurity: a preliminary trial. Am J Ophthalmol. 2007;144:139–41.

    Article  PubMed  Google Scholar 

  47. Wu WC, Drenser KA, Lai M, et al. Plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity. Retina. 2008;28:S75–80.

    Article  PubMed  Google Scholar 

  48. Wong SC, Capone A Jr. Microplasmin (ocriplasmin) in pediatric vitreoretinal surgery: update and review. Retina. 2013;33(2):339–48.

    Article  PubMed  Google Scholar 

  49. Honda S, Hirabayashi H, Tsukahara Y, Negi A. Acute contraction of the proliferative membrane after intravitreal injection of bevacizumab for advanced retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol. 2008;246:1061–3.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ophthalmology, KYDOFT Foundation, Av Luis Pasteur 5280 of 304, Santiago, Chile

    Andrés Kychenthal B. & Paola Dorta S.

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  1. Andrés Kychenthal B.
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  2. Paola Dorta S.
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Correspondence to Andrés Kychenthal B. .

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  1. KYDOFT, Santiago, Chile

    Andrés Kychenthal B.

  2. KYDOFT, Santiago, Chile

    Paola Dorta S.

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Kychenthal B., A., Dorta S., P. (2017). Management of Stage 4 ROP. In: Kychenthal B., A., Dorta S., P. (eds) Retinopathy of Prematurity. Springer, Cham. https://doi.org/10.1007/978-3-319-52190-9_9

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  • DOI: https://doi.org/10.1007/978-3-319-52190-9_9

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  • Publisher Name: Springer, Cham

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