LONG-TERM VISUAL RESULTS OF CHILDREN AFTER INITIALLY SUCCESSFUL VITRECTOMY FOR STAGE-V RETINOPATHY OF PREMATURITY

Purpose: To assess the effectiveness of vitrectomy for stage V retinop athy of prematurity (ROP) at the authors' institution, 33 patients wit h ROP who had initially successful total or partial anatomic retinal a ttachments (51 eyes) were evaluated for visual function and long-term anatomic stability. In addition, this study was an attempt to differen tiate levels of visual function in children with very low vision and a ttendant developmental delays. Methods: Visual function was assessed b efore retinal examination by an experienced pediatric vision specialis t. The behavioral visual assessment was divided into seven segments wi th two to five tasks in each segment designed to establish a level of functional vision, ranging from light perception to form identificatio n (and ambulation). The status of the retina was classified by the pat ient's retinal surgeon. Results: The median follow-up was 61 months, a nd median age at the time of examination was 68 months. Of 51 eyes tre ated, form identification was achieved in 5, and all five patients had ambulatory vision. Of 51 eyes, 15 had no light perception, II had lig ht perception, 6 could localize light, 10 could follow lights, and 4 w ere able to detect form. Only one eye in ten children with comparable ROP in each eye underwent surgery, and vision improved in six of ten o f the surgical eyes. Redetachment was high, with 35 retinas totally or partially detached and only 13 retinas fully attached 61 months after surgery. Conclusion: The visual results are very low and disappointin g. Initially successfully attached retinas can detach. There is some e vidence that vitrectomized eyes function better than nonvitrectomized eyes. There is also evidence that visual function lower than form iden tification is useful to these children and that they are able to use t heir limited vision better than previously thought.