Anatomical and visual outcome of stages 4 and 5 retinopathy of prematurity.

AIM: To describe our experience in surgical management of stages 4 and 5 retinopathy of prematurity (ROP) and assess its anatomical and visual outcome. MATERIALS AND METHODS: This study is a retrospective, interventional, consecutive case series. It involved 33 eyes of 29 infants. The data were retrieved retrospectively for each case from their medical records. All the eyes underwent primary vitrectomy with additional procedures like scleral buckling (two eyes), lensectomy (14 eyes), subretinal fluid drainage (two eyes), and one case of corneal transplant (open sky vitrectomy). The anatomical and visual outcome was reviewed at the final follow-up. RESULTS: The mean gestational age was 29.7 weeks (range 25-34 weeks) and mean birth weight was 1332 g (range 650-2050 g). Anatomical success for stage 4A was defined as complete retinal attachment with undistorted or minimally distorted posterior pole. For stage 4B, partial residual retinal detachment and for stage 5 at least posterior pole attachment. Visual acuity was measured in anatomically successful eyes that were cooperative. The anatomical outcome was 90% (9/10 eyes) for stage 4A, 44.4% (4/9 eyes) for stage 4B, and 14.3% (2/14) for stage 5. The mean follow-up was 19.1 months. Posterior retinotomy was the commonest complication for stage 4B (66.7%). CONCLUSION: Anatomical and visual success was the best for stage 4A ROP. Surgery for stage 4A can halt progression to stages 4B or 5 ROP. Aggressive peeling of posterior membranes should be avoided for stage 4B. Anatomical and visual outcome is very poor for stage 5.

Choroidal granulomas in systemic sarcoidosis.

PURPOSE: To evaluate the clinical course, including response to therapy, of patients with macular and peripapillary choroidal granulomas secondary to systemic sarcoidosis. METHODS: This is a retrospective case study and literature review. Nine patients with choroidal granulomas were identified. Eight patients had a tissue biopsy confirming sarcoidosis; one was diagnosed from clinical history and typical gallium scan. Ocular examinations included fundus examination, fluorescein angiography, and visual field examination. Eight patients had magnetic resonance imaging (MRI) scans looking for intracranial granulomas. Treatment consisted of oral prednisone in eight patients (one with concomitant subconjunctival triamcinolone); one patient received no treatment because of good vision and granuloma in the nasal retina. Variables studied included visual acuity (VA), response of granulomas to treatment, time to recurrence, and associated anterior segment findings. RESULTS: Eight of nine patients had a solitary lesion whereas one had multifocal involvement. The granulomas ranged in size from one half to four disk diameters. Eight patients had blurry vision; one was asymptomatic. All nine patients had hilar adenopathy and/or pulmonary parenchymal disease. No patient had nonocular neurologic symptoms and in eight patients who underwent MRI examination no intracranial granulomas were detected. Of the eyes that were treated (n = 8) all had decrease in the size of the choroidal mass at an average of 4 months of treatment. Two had complete resolution. Mean follow-up was 29.2 months. At the time of initial diagnosis only one patient had an active anterior uveitis. Five of nine patients had at least one recurrence. Mean time to recurrence was 7.6 months after discontinuing oral prednisone. The VA at presentation ranged from 20/30 to 20/300. Final VA was 20/30 or better in all patients. CONCLUSIONS: Choroidal granulomas related to systemic sarcoidosis respond well to oral corticosteroids. They may recur but good vision can be maintained. They are not typically associated with concomitant iritis and also do not appear to be associated with intracranial granulomas.

Posterior repositioning of glaucoma implants for anterior segment complications.

OBJECTIVE: To assess the efficacy of repositioning Baerveldt aqueous implant tubes from the anterior chamber into the vitreous cavity in the management of anterior chamber tube-related complications. DESIGN: Noncomparative case series. PARTICIPANTS: Nine eyes of eight consecutive subjects with anterior segment problems (corneal decompensation with a shallow anterior chamber or recurrent tube erosion unresponsive to conventional revision). INTERVENTION: Baerveldt implant tubes were repositioned from the anterior chamber into the vitreous cavity after pars plana vitrectomy. MAIN OUTCOME MEASURES: Preservation of visual acuity, maintenance of intraocular pressure (IOP) control, and resolution of the anterior segment problem. RESULTS: Nine eyes of eight subjects were collaboratively managed by the operating glaucoma and vitreoretinal surgeons and followed postoperatively for an average time of 17 months (range, 2-42 months). Visual acuity remained stable or improved in seven of the nine eyes. IOP remained controlled in all eyes, with an average IOP of 14.3 +/- 3.0 standard deviation mmHg (range, 10-18 mmHg). Progression of the anterior segment problem, which dictated the revision, was halted in three of five eyes with corneal decompensation and shallow anterior chambers and in all eyes with recurrent tube erosion. Postoperative complications included one successfully repaired retinal detachment occurring 9 months postoperatively. CONCLUSIONS: Repositioning of an anterior chamber Baerveldt shunt tube into the vitreous cavity is a viable option for resolving recalcitrant tube-related anterior segment complications.