Rare and severe complications following surgical treatment of retinopathy of prematurity according to the vitrectomy method – case report

Monika Modrzejewska, Wiktoria Bosy, Patrycja Woźniak

Abstract


Introduction: Retinopathy of preterm infants is a serious condition that can lead to various complications, such as severe vision loss, blindness, and other sequelae of progressive disease in premature infants. In this paper, we report the complication of ciliary body hernias resulting from high intraocular pressure in the afflicted eye combined with secondary glaucoma after vitrectomy due to retinopathy of prematurity (ROP), a condition previously not described in the literature (PubMed or Google Scholar from 2014–2022).
Material and methods: The infant underwent photocoagulation treatment twice due to ROP due to ROP stage 4/5. At 4th months of life, the baby underwent posterior vitrectomy with lensectomy, with the final injection of sodium hyaluronate to the vitreous chamber. The child did not suffer from any autoimmune diseases or keratitis. The only risk factors included photocoagulation and vitrectomy with the reconstruction of both the anterior chambers and the pupil.
Results: Following posterior vitrectomy, the child manifested multiple complications, such as hernia of the ciliary body, secondary glaucoma, leucoma, hemorrhage to the anterior eye chamber, keratomalacia, and advanced keratopathy. Autoimmune diseases, avitaminosis, the inflammatory of the cornea (of no iatrogenic etiology) and viral or bacterial infections were excluded. Nevertheless, positive bacterial cultures from natural body orifices obtained in routine examinations during hospitalization could cause a severe course of ROP as well as complicated outcomes of surgical treatment.
Conclusions: Vitrectomy is the last resort therapeutic option (ROP stage 4A, 4B, 5), as it might result in keratopathy, cataract, glaucoma, strabismus, or severe hyperopia. Due to severe damage to the eye structures that may occur after surgical vitrectomy in premature infants in the course of ROP, this technique should only be used by experienced vitrectomists with great care and caution, especially in extremely low-birthweight children.

Keywords


retinopathy of prematurity; corneal malacia; iris hernia; ciliary hernia; vitrectomy; secondary glaucoma

Full Text:

PDF

References


Wood EH, Chang EY, Beck K, Hadfield BR, Quinn AR, Harper CA 3rd. 80 years of vision: preventing blindness from retinopathy of prematurity. J Perinatol 2021;41(6):1216-24.

Simkin SK, Misra SL, Han JV, McGhee CNJ, Dai S. Auckland regional telemedicine retinopathy of prematurity screening network: a 10-year review. Clin Exp Ophthalmol 2019;47(9):1122-30.

Grałek M, Lewandowska M, Niwald A. Zapobieganie i leczenie retinopatii wcześniaków w Polsce w latach 2003–2012. Fam Med Primary Care Rev 2013;15(2):106-8.

Fortes Filho JB, Eckert GU, Valiatti FB, Dos Santos PGB, da Costa MC, Procianoy RS. The influence of gestational age on the dynamic behavior of other risk factors associated with retinopathy of prematurity (ROP). Graefes Arch Clin Exp Ophthalmol 2010;248(6):893-900.

The data retrieved from the registry of The Great Orchestra of Christmas Charity (M. Grałek’s report – program coordinator in 2016–2021).

Shah PK, Prabhu V, Karandikar SS, Ranjan R, Narendran V, Kalpana N. Retinopathy of prematurity: Past, present and future. World J Clin Pediatr 2016;5(1):35-46.

Popovic MM, Nichani P, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. Intravitreal antivascular endothelial growth factor injection versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3,701 eyes. Surv Ophthalmol 2021;66(4):572-84.

Wu WC, Kuo JZ. Complications of retinopathy of prematurity treatment. In: Kychenthal BA, Dorta SP, editors. Retinopathy of Prematurity. Current Diagnosis and Management. Berlin: Springer; 2017. p. 119-28.

Morrison D, Shaffer J, Ying GS, Binenbaum G. Ocular complications following treatment in the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study. J AAPOS 2018;22(2):128-33.

Kang HG, Choi EY, Byeon SH, Kim SS, Koh HJ, Lee SC, et al. Intravitreal ranibizumab versus laser photocoagulation for retinopathy of prematurity: efficacy, anatomical outcomes and safety. Br J Ophthalmol 2019;103(9):1332-6.

Karacorlu M, Hocaoglu M, Sayman Muslubas I, Arf S. Long-term functional results following vitrectomy for advanced retinopathy of prematurity. Br J Ophthalmol 2017;101(6):730-4.

Nilsson M, Hellström A, Jacobson L. Retinal sequelae in adults treated with cryotherapy for retinopathy of prematurity. Invest Ophthalmol Vis Sci 2016;57(9):OCT550-5.

Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Child 2017;102(9):853-7.

Gotz-Więckowska A, Bakunowicz-Łazarczyk A, Hautz W, Filipek EV, Niwald AM. Polish Ophthalmological Society revised guidelines for the management of retinopathy of prematurity. Acta Ophthalmol Pol 2020;122(1):14-6.

Erginturk Acar D, Acar U, Tunay ZO, Ozdemir O. The effect of laser photocoagulation on intraocular pressure in premature infants with retinopathy of prematurity. J Glaucoma 2017;26(2):e74-8.

Praidou A, Brazitikos P, Dastiridou A, Androudi S. Severe unilateral corneal melting after uneventful phacoemulsification cataract surgery. Clin Exp Optom 2013;96(1):109-11.

Arun V. Postoperative corneal melt clinical presentation. www.emedicine.medscape.com/article/1193347-clinical#b5 (29.08.2019).

Krachmer JH, Mannis MJ, Holland EJ. Cornea: fundamentals, diagnosis and management. 3rd ed. Oxford: Mosby/Elsevier; 2011.

Matsubara M, Zieske JD, Fini ME. Mechanism of basement membrane dissolution preceding corneal ulceration. Invest Ophthalmol Vis Sci 1991;32(13):3221-37.

Hazlett LD. Corneal response to Pseudomonas aeruginosa infection. Prog Retin Eye Res 2004;23(1):1-30.

Modi KK, Chu DS, Wagner RS, Guo S, Zarbin MA, Bhagat N. Infectious ulcerative keratitis following retinopathy of prematurity treatment. J Pediatr Ophthalmol Strabismus 2015;52(4):221-5.

Sommer A. Effects of vitamin A deficiency on the ocular surface. Ophthalmology 1983;90(6):592-600.

Zhang F, Min Y, Yu Y, Xu N, Wang W, Wu S. Vitamin A deficiency and its treatment in captive Sunda pangolins. Vet Med Sci 2021;7(2):554-8.

Wadhwani M, Singh R. Bilateral keratomalacia leading to blindness secondary to diet-induced vitamin A deficiency in infants. J Pediatr Ophthalmol Strabismus 2020;57:e12-4.

Kumar A, Raj A. Intraoperative floppy iris syndrome: an updated review of literature. Int Ophthalmol 2021;41(10):3539-46.

Lenis TL, Ledesma Vicioso N, Reddy V, Kovacs KD, Van Tassel SH, Orlin A. Case report: glaucoma in an infant with retinopathy of prematurity. Front Pediatr 2021;9:786327.

Celik G, Gunay M, Vural A, Kizilay O. Foveal thickness, foveal microvasculature, and refractive error in children with asymmetric involvement of retinopathy of prematurity. Eur J Ophthalmol 2021;31(2):759-65.




DOI: https://doi.org/10.21164/pomjlifesci.839

Copyright (c) 2022 Monika Modrzejewska, Wiktoria Bosy, Patrycja Woźniak

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/