Evaluation of risk factors for postoperative prolonged intubation in premature infants after cryotherapy for retinopathy of prematurity.

OBJECTIVE: Premature infants are more prone to cardiorespiratory complications after surgery than term infants. Risk factors for postoperative apnea include post-conception age, gestational age, postnatal age, birth weight, history of respiratory distress syndrome, bronchopulmonary dysplasia, anemia, necrotizing enterocolitis, use of opioids or nondepolarizing muscle relaxants, aminophylline use, history of apnea, body weight at operation, and pre-existing disease. The aim of this study was to identify the most important factors associated with postoperative extubation and respiratory outcomes among premature infants undergoing cryotherapy for retinopathy of prematurity (ROP). METHODS: We retrospectively analyzed the clinical records of 62 premature infants, with mean +/- standard deviation gestational age of 26.4 +/- 2.3 weeks, birth weight of 914.8 +/- 208.5 g, postconception age of 37.0 +/- 2.8 weeks, and body weight at the time of operation of 1970.0 +/- 446.8 g, who underwent cryotherapy for ROP. RESULTS: Only 17 infants were successfully extubated within 2 hours after operation. The most predictive factor for successful or unsuccessful extubation was body weight at the time of operation. CONCLUSION: Body weight at the time of operation was the most important factor associated with postoperative ventilatory support among premature infants under-going cryotherapy for ROP.

Pneumatic displacement of a dense submacular hemorrhage with or without tissue plasminogen activator.

BACKGROUND: To evaluate the efficacy of treating a dense submacular hemorrhage with pneumatic displacement with or without tissue plasminogen activator (tPA). METHODS: Twenty-four patients with a dense submacular hemorrhage were treated with intravitreal expansile gas, with or without an intravitreal injection of tPA, in order to displace the submacular blood. The main outcome measurements include preoperative and postoperative visual acuity, postoperative fluorescein angiography (FAG) results and additional postoperative treatments. RESULTS: Total or subtotal subfoveal blood displacement was achieved in all 24 eyes. After a mean follow-up of 15.5 months (range 6-50 months), final visual acuity had improved two or more lines in 11 (45.8%) of the 24 eyes, and measured 20/100 or better in 10 (41.7%) of the 11 eyes. Based on the FAG results for 14 cases, nine eyes (64.3%) received additional postoperative laser treatment. Final visual acuity of 20/100 or better was achieved in four (40%) of the 10 eyes, with a choroidal neovascular membrane (CNVM) detected on FAG, and dye leakage not detected in three (75%) of the four eyes. CONCLUSIONS: Pneumatic displacement, with or without intravitreal injection of tPA, seems useful in displacing dense submacular hemorrhage and facilitating visual improvement, although the visual result is often limited by the progression of the underlying macular disease. In patients with age-related macular degeneration, more treatable CNVM may be detected on postoperative FAG.

Visual results and complications after trans pars plana vitrectomy and lensectomy for lens dislocation.

BACKGROUND: The aim of this study is to determine the relationship between the cause of lens dislocation and visual outcomes with complications in patients undergoing trans pars plana vitrectomy (TPPV) and trans pars plana lensectomy (TPPL) for lens dislocation. METHODS: This retrospective study was carried out from July 1995 through November 2003. After excluding patients with previous retinal detachment or combing lens dislocation and post-TPPV/TPPL follow-up intervals of less than 6 months, 36 eyes from 36 patients who had undergone vitrectomy and lensectomy for lens subluxation or dislocation due to trauma or intraocular surgery were examined. Their presenting features and complications were recorded. The relationship between the cause of lens dislocation and visual outcome with complications was tested using Fisher's exact test. RESULTS: The cause of lens dislocation included blunt and penetrating eye trauma, and intraocular surgery. Final best-corrected visual acuity was 20/40 or better in 45% of eyes in the traumatic arm and in 31% of eyes in the iatrogenic arm. Visual acuity improved after TPPV/TPPL in 90% of the eyes in the traumatic arm and in 81% of the eyes in the iatrogenic arm. Of all of the eyes, 39% had significant complications affecting postoperative visual outcomes, including retinal detachment, cystoid macular edema, vitreous hemorrhage and glaucoma. CONCLUSIONS: There were no significant differences in visual outcomes and complications between the traumatic and iatrogenic arms of the study. Therefore, the cause of lens dislocation was not a predictor of visual outcomes. Nonetheless, posterior segment complications including retinal detachment and glaucoma were major causes of poor postoperative visual outcomes.