Plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity.

PURPOSE: To review the surgical outcome of plasmin enzyme-assisted vitreoretinal surgery in managing stage 5 retinopathy of prematurity (ROP).

METHODS

A retrospective, consecutive interventional cases series of 80 eyes (68 patients) with stage 5 ROP, treated with autologous or maternal plasmin enzyme-assisted vitreoretinal surgery, were reviewed. All study patients underwent surgery between 1995 and 2004 with plasmin enzyme-assisted vitreoretinal surgery. Thirty-eight eyes had previous vitreous surgery without retinal breaks (Group 1). Fifteen eyes had previous vitreous surgery with retinal breaks (Group 2). Twenty eyes received previous laser, and/or cryotherapy, and/or scleral buckling, but no vitrectomy (Group 3). Seven eyes did not receive any treatment previously (Group 4).

RESULTS

Postoperative anatomic outcome, functional results, and surgical complications in each group of eyes at an average follow-up of 49 months were recorded. Following surgery of all 80 eyes, anatomic success was achieved in 68.8%. Six eyes (7.5%) achieved 20/60 to 20/600 vision. Fifty-nine eyes (73.8%) achieved vision worse than 20/600 to light perception. Eleven eyes (13.8%) achieved no light perception. Visual results were uncertain in 4 eyes (5%) because of the inability to measure reliably.

CONCLUSION

Plasmin enzyme-assisted vitrectomy in eyes with and without previous vitrectomy surgery can achieve visual improvement in stage 5 ROP. Early intervention with vitreous surgery for stage 4A ROP will achieve better anatomic and visual results and reduce the number of children with stage 5 ROP.