Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2016
Student: CEMAL ÖZSAYGILI
Supervisor: ŞENGÜL ÖZDEK
Abstract:Despite the current treatment strategies in developing and developed countries, ROP is one of the most preventable blindness cause. Treatment of ROP associated RD is surgery. There are different success rates for stage 4-5 ROP in the form of case series in the literature but limited studies has been published on factors influencing anatomical and functional success. We retrospectively investigated the anatomical and functional results of ROP surgeries together with factors influencing the success. The reports of cases with stage 4-5 ROP who have had vitreoretinal surgery between May 2011-May 2016 by one single surgeon were evaluated. One hundred sixty two eyes of 110 patients (55 female/55 male) were included in the study. Patient's birth week, birth weight, disease stage, existence of plus disease, preoperative treatment status, surgery performed gestational week, surgery type (Lens Sparing Vitrectomy/Lensectomy Vitrectomy), postoperative anatomical and functional success, the ratio of Ftizis Bulbi and leukokoria in failed patients, peroperative and postoperative complications, the need of additional surgery and total length of follow up were noted. ICROP was used for staging. Preoperative treatment were categorized as laser, anti-VEGF and combination of these. Surgeries were categorized as LSV and LV and entry site were categorized as pars plicata, trans iris root and limbal. Successful anatomical results were described as total anatomic reattachment with minimal/without macular distortion for stage 4A, total anatomic reattachment or/and reattachment of posterior pole with localized peripheral RD for stage 4B, total anatomical reattachment or/and reattachment of posterior pole or/and peripheral retinal attachment providing ambulatory vision for stage 5. Total RD was determined as failure for all stages. Visual results were tested for central steady maintained fixation during 0-1 years age, for starting walking alone, playing with small toys, fixation and following small objects during 1-2 years age, for Lea symbol during 2-3 years ages and for E chart during 3-4 years ages and for E chart and snellen/ETDRS chart during 4 or more years age. We identified the functional success for older than two years old patients as having ambulatory vision (snellen 20/2000, logmar 1.80) or better visual acuity. Mean birth week was 28.4±2.7 (23-35) week and mean birth weight was 1184±406 grams (580-2580). One hundred two of 162 eyes had either immediate or delayed sequential bilateral surgery. Most of eyes were stage 4A (46.9%) and stage 5 eyes were the least (22.8%). Majority of eyes had plus disease (63%). Nearly one fifth of the eyes had no preoperative treatment (22.2%). Surgeries were performed at mean postmenstrual 43.7±7.9 week. Nearly one fifth of the eyes (19.5%) needed a second surgery after a mean of 25.8±55.1 weeks following the first surgery. Air was the most commonly used tamponade in all surgeries (67.7%). Anatomical success rate was 87.5%, 91.7% and 95.8% for stage 4A eyes; 67.3%, 69.4% and 57.9% for stage 4B eyes; 29.7%, 28.6% and 29.4% for stage 5 eyes for the 1st,2nd and 3th years respectively. Functional success rate was 84.2% and 91.8% for stage 4A eyes; 67.3% and 61.8% for stage 4B eyes; and 27% and 21.7% for stage 5 eyes for the 1st and 2nd years respectively. The eyes completing the third year follow up had a mean visual acuity of 1.16±0.3 (0.52-1.80) logMAR and 37.1% of them reached ≤ 1 logMAR visual acuity. Twenty four eyes in stage 4A (100%), ten eyes in stage 4B (100%) and one eye in stage 5 (100%) reached the ambulatory vision, which was 1.8 logMAR. The effect of plus disease on early anatomic and functional success was found statistically significantly (respectively p:0.048, 0.047) and the eyes which had plus disease the success rate was lower at all stages. It has been observed that the location of the disease is differ and it has been detected that the success ratio was low when the disease is located closer to macula. Within two-year observation period it has been attended that, accomplishment rate was significantly lower than all other stages in zone 1 localization (p<0.05) and in three-year observation period it has been obtained that; accomplishment ratio in 4B stages was much lower (p:0.001). Due to two-year observation period outcome, functional success rate was notably higher in 4A and 4B stages at zone 2 localizations (p<0.05). Anatomical success rate was significantly higher in preoperatively treated cases (respectively p:0.044, 0.029) during two year follow up period, while functional success was higher for the cases which completed two year follow up period (p:0.007). It has been ascertained that, none of the treatment method is superior to one another (p>0.05). During the evaluation of effect of surgery method, it has been obtained that, anatomical success rate was higher for the cases which LSV surgery is applied in first three years while functional prosperity was significantly higher in the first two years for such cases (p:<0.001). Posterior hyaloid detachment effect in following years has detected to be positive success on anatomy (p<0.001). Once again when the effect of AVD on functional success has been examined, it has been detected that; the AVD induction, in first two years of functional succeed eyes has found more successful compared to unsuccessful group. It has been found out that the most developed complication was vitreous haemorrhage (35.1%). According to our observations; growth factors in haemorrhage cause proliferation of residual tissues, influence the success rates and that cause an important reason for early failure. As a matter of fact, the cases which had postoperative vitreous haemorrhage, anatomical success rate was observed significantly low for first and third year (respectively p:0.013, 0.042) and functional success was significantly low either (p:0.02). The postoperative vitreous haemorrhage less developed in eyes which preoperative treated with anti-VEGF agents and the difference was significant for stage 4A eyes (p:0.002). The relationship between postoperative vitreous haemorrhage and plus disease was significant for all stages (respectively for stages p<0.001, p<0.001, p: 0.016). We care achievement of posterior hyaloid detachment for the cases that developed postoperative vitreous haemorrhage. We investigated the effect of posterior hyaloid detachment on postoperative haemorrhage resolution. The requirement of second surgery in eyes which achieved posterior hyaloid detachment was 21,7% and 41.2% for cases that could not achieve hyaloid detachment peroperatively. Another crucial complication for pediatric VRC was iatrogenic tear. The anatomical and functional failure was significantly higher for the first two-year period in the cases which had iatrogenic tear (respectively for the first and second anatomical success p:0.01, 0.009 and for the first and second functional success p:0.003, 0.001). In accordance with stage analysis; , the anatomical and functional success rate was significantly low for stage 4A cases, and for stage 5 cases which had iatrogenic tear, neither anatomical and nor functional success has been achieved. Glaucoma has been developed at nearly one tenth of the cases (9.8%) and many of them has taken under control by medical treatment (87.5%). Glaucoma development rate was higher in LV performed cases when compared to LSV surgery applied cases, however the difference was not statistically significant (10.4% vs 9.6%). FB and leukokoria has been detected at almost half of the cases (44.7%) where postoperative success cannot be reached, however such diagnosis shall only be named as cosmetic failure.