Glaucoma after Lens-Sparing Vitrectomy for Advanced Retinopathy of Prematurity

Eric Nudleman; Ilkay Kilic Muftuoglu; Raouf Gaber; Joshua Robinson; Kimberly Drenser; Antonio Capone; Michael T Trese

doi:10.1016/j.ophtha.2017.11.009

Glaucoma after Lens-Sparing Vitrectomy for Advanced Retinopathy of Prematurity

Ophthalmology. 2018 May;125(5):671-675. doi: 10.1016/j.ophtha.2017.11.009. Epub 2017 Dec 11.

Authors

Eric Nudleman¹, Ilkay Kilic Muftuoglu², Raouf Gaber³, Joshua Robinson⁴, Kimberly Drenser⁵, Antonio Capone⁵, Michael T Trese⁶

Affiliations

¹ Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California; Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
² Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California.
³ Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, San Diego, California; Department of Ophthalmology, Tanta University, Tanta, Egypt.
⁴ Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Ophthalmology, Emory Eye Center, Emory University, Atlanta, Georgia.
⁵ Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
⁶ Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Electronic address: mgjt46@aol.com.

PMID: 29241743
DOI: 10.1016/j.ophtha.2017.11.009

Abstract

Purpose: To report the incidence of, and factors related to, glaucoma after lens-sparing vitrectomy (LSV) surgery in advanced retinopathy of prematurity (ROP).

Design: Retrospective case series at a single tertiary referral pediatric vitreoretinal practice.

Participants: Four hundred and one eyes from 270 patients were included.

Methods: The medical records of patients who underwent LSV for stage 4A, 4B, and 5 ROP were retrospectively reviewed. Data were collected from patient charts including gender, gestational age at birth, birthweight, stage of ROP at presentation, prior treatment (laser or cryotherapy), subsequent retinal surgeries, presence of glaucoma, time to glaucoma (interval between LSV and the onset of glaucoma), date of lensectomy (if performed), and retinal attachment status at last visit. Lensectomy was considered as a time-dependent covariate in the analysis.

Main outcome measures: Incidence of glaucoma and potential risk factors for time to glaucoma.

Results: Among 401 eyes with advanced ROP, 40 eyes (10.0%) had glaucoma during a mean of 3.06±4.11 years of follow-up. The incidence of glaucoma was 6.9% (17/247) in stage 4A, 12.0% (16/133) in stage 4B, and 33.3% (7/21) in stage 5 ROP. Twenty-one percent of eyes (87/401) required lensectomy at a mean of 1.23±2.19 years after LSV. In univariate analysis, having stage 5 ROP (vs. stage 4 ROP) and presence of lensectomy were found to be significantly associated with time to glaucoma (hazard ratio = 6.76, 95% confidence interval = 2.19-20.88, P = 0.001; hazard ratio = 3.06, 95% confidence interval = 1.56-6.0, P = 0.001, respectively). In multivariate analysis, lensectomy was the only significant independent factor associated with time to glaucoma (hazard ratio = 2.76, 95% confidence interval = 1.371-5.581, P = 0.004).

Conclusions: Patients with more severe ROP had a higher incidence of glaucoma after lens-sparing vitrectomy. If a patient required lensectomy owing to progression of ROP and/or presence of lens opacity, then the hazard of having glaucoma significantly increased compared with those without lensectomy.

MeSH terms

Birth Weight
Child
Child, Preschool
Female
Follow-Up Studies
Gestational Age
Glaucoma / etiology*
Glaucoma / surgery
Humans
Incidence
Infant
Infant, Low Birth Weight
Lens, Crystalline / surgery
Male
Retinopathy of Prematurity / surgery*
Retrospective Studies
Risk Factors
Visual Acuity
Vitrectomy / adverse effects*