Abstract
Objectives
To audit the structural and functional outcomes of surgery for acute tractional retinal detachment due to retinopathy or prematurity between 2004 and 2014 in Oxford UK.
Methods
Consecutive operations were identified from a surgical log. Clinical data including demography, perioperative data, and retinal outcomes were extracted into a spreadsheet and compared against two international data sets referenced in the method section. Nonparametric tests (Fisher’s exact, and the Mann–Whitney U-tests) were used for statistical analysis with a p-value < 0.05 considered significant.
Results
Twenty-nine eyes of 19 babies underwent surgery. The mean age (SD) at final follow-up was 6.4 (3.7) years of age and comparable to the reference data sets. The mean birth weight and gestational age of babies matched the ETROP data set referenced in the method section. Anatomical success was obtained in 16/29 (55.2%) of eyes and more likely with stage 4 ROP than stage 5 disease (p < 0.05). Thirteen of 29 eyes (44.8%) obtained form vision post-operatively. All instances of macular retinal reattachment during follow up were verified with post-operative OCT.
Conclusions
Surgery for stage 5 ROP is not worthwhile. For stage 4 ROP it yielded better visual outcomes than ETROP but registration for visual impairment was not prevented. Innovation such as endoscopic vitrectomy could yield better outcomes. Earlier detection of vitreoretinal fibrosis could result in timelier referral. A formally funded national service is needed to ring-fence resource to avoid delays in access to surgery, which has a narrow surgical window.
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Acknowledgements
The delivery of care for the babies described in this study would not have been possible without contributions from a multidisciplinary team of medical (neontologists, paediatric anaesthetists, vitreoretinal fellows, specialist registrars) and non-medical staff (nurses, orthoptists, optometrists) of the Oxford Eye Hospital and Oxford University. I must acknowledge the help of Professor Andrew Farmery for his airway management expertise that facilitated the initial development of OCT imaging under anaesthesia and the subsequent fund-raising efforts of hospital staff and parents to develop the Spectralis OCT. I am very grateful for the dedication of the imaging team with special thanks extended to Anne Bolton, Lewis Smith and Jon Brett. Ozdemir Ozdemir, a paediatric ophthalmologist from Istanbul was an observer who I would like to thank for some of the data collection to assist with the audit.
Funding
As this work describes an audit of clinical activity in a National Health Setting no funding has been required for the study. The cost of publication of will be met from University of Oxford research funds.
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No funding was required or provided for this audit. CK Patel has received fees from Optos and Heidelberg engineering for lectures on retinal imaging in children. CK Patel conceived the methodology that was reviewed and modified by contributions from all authors (CKP, EC, RH, SCW, SB), who also participated in the writing and review of the written article. None of the other authors have any conflict of interest to declare relevant to the content of this publication.
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Patel, C.K., Carreras, E., Henderson, R.H. et al. Evolving outcomes of surgery for retinal detachment in retinopathy of prematurity: the need for a national service in the United Kingdom. Eye 36, 1590–1596 (2022). https://doi.org/10.1038/s41433-021-01679-8
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DOI: https://doi.org/10.1038/s41433-021-01679-8
