Retinopathy of Prematurity Staging System Predictive of Vitrectomy Success

New guidelines for disease stage subclassification in retinopathy of prematurity (ROP) can foretell postoperative anatomical success of vitrectomy, researchers report in a study published in Retina. The study evaluated the outcomes of patients who underwent the procedure for ROP who were staged according to the International Classification of Retinopathy of Prematurity third edition (ICROP 3).

Investigators retrospectively analyzed the outcomes of patients categorized according to the 3 subgroups of ICROP 3’s definition of stage 5 retinopathy of prematurity (5A, 5B, and 5C) all of whom underwent vitrectomy between 2004 and 2020. The team conducted a multivariate analysis, corrected for confounding demographic and clinical variables, to test the association between subgroup and outcomes.  

A total of 54 eyes of 34 patients (median gestational age, 24 weeks and 2 days; 76.5% men, 23.5% women) were included in the study. Patients were subclassified as 33.3% stage 5A, 61.1% stage 5B, and 5.6% stage 5C.

The researchers found that complete retinal reattachment was achieved in 88.9% of eyes with stage 5A and 39.4% of eyes with stage 5B (P =.0003); the 3 patients with stage 5C were considered inoperable due to highly complex retinal detachment. 

The team demonstrated that postoperative anatomical failure was associated with stage (stage 5B vs 5A; odds ratio, 17.986; 95% confidence interval, 3.712-148.502; P =.0001). They also observed that intraoperative intravitreal injection of bevacizumab was associated with lower postoperative incidence of vitreous hemorrhage and glaucoma (P =.041).

“Staging of preoperative anatomical features based on ICROP 3 seems to be clinically meaningful because the anatomical results of surgery for stage 5A are much better than that for stage 5B,” according to the researchers.

The study was limited by the low number of cases evaluated, its retrospective nature, and a short follow-up period.