Primary vitrectomy in the treatment of retinopathy of prematurity with unfavorable progression

Purpose. The study aims to determine the indications and evaluate the results of primary vitrectomy in unfavorable progression of stage III active retinopathy of prematurity (ROP). Material and methods. The control group consisted of 17 patients (28 eyes) with unfavorable progression of stage III ROP, who had the disease progress after coagulation of the avascular retina and underwent the second stage of treatment — vitrectomy. The main group consisted of 5 patients (10 eyes) with unfavorable progression of stage III ROP, who underwent primary vitrectomy. Gestational age at birth was 24—30 weeks, body weight ranged from 680 to 1250 g. According to spectral optical coherence tomography (SOCT) and OCT angiography (OCT-A), the initial state of the retina and vitreoretinal interface in patients of the main and control groups were identical. Results. A retrospective analysis of control patients, according to SOCT and OCT-A data, showed the spread of neovascularization beyond the retinal plane, its interaction with the posterior hyaloid membrane and vitreous body structures in the early stages of the disease, traction changes in the underlying retina, areas of retinoschisis, as well as thickening of the posterior hyaloid membrane. The tactics of treating patients with unfavorable progression of stage III ROP has changed since 2020. Primary vitrectomy was performed in case the signs listed above were identified. The transition of the disease to the inactive stage was recorded in all cases one month after primary vitrectomy. After one year the pathological process did not reactivate in any of the cases, and no pathological changes were found in the projection of the former proliferation ridge. Conclusions. Extraretinal retinovitreal neovascularization, according to multimodal preoperative diagnostics, indicates the need for vitreoretinal surgery as a pathogenetically substantiated method of treatment for unfavorable progression of stage III active ROP.