Lensectomy and vitrectomy with and without intravitreal triamcinolone acetonide for vascularly active stage 5 retinal detachments in retinopathy of prematurity

PURPOSE: To determine the anatomical success rate of lensectomy and vitrectomy with and without intravitreal triamcinolone acetonide (TA) for vascularly active stage 5 tractional retinal detachments due to retinopathy of prematurity (ROP). METHODS: In a retrospective, interventional, single-surgeon, consecutive case series, the records of 21 eyes of 21 patients presenting with stage 5 retinal detachment secondary to ROP who underwent primary pars plicata vitrectomy with lensectomy from February 1998 to January 2004 were evaluated. All eyes were vascularly active at the time of surgery. Eleven eyes underwent the surgical procedure without TA (group 1), and 10 eyes received TA at the end of the procedure (group 2). The main outcome measure, retinal reattachment, was reviewed at the final follow-up visit, which ranged from 6 months to 42 months (mean, 28 months) after surgery. RESULTS: None (0/11) of the eyes in group 1 maintained attachment, while 6 (60%) of 10 eyes in group 2 maintained at least posterior pole reattachment at the final visit. None of the group 2 eyes exhibited plus disease during follow-up. None of the eyes in either group exhibited signs of increased intraocular pressure after surgery. All six eyes that maintained posterior pole reattachment were able to fix and follow light at the last follow-up visit. CONCLUSIONS: Vascularly active stage 5 ROP detachments portend a poor progress. The use of TA as a postoperative adjunct may improve the likelihood of retinal reattachment in select cases.