Refractive outcomes of lens-sparing vitrectomy for retinopathy of prematurity

Objective: To evaluate the refractive outcomes of 3-port lens-sparing vitrectomy (LSV) for subtotal retinal detachments owing to retinopathy of prematurity. Methods: The study included 9 infants who had undergone complete ablative laser treatment for threshold retinopathy of prematurity in both eyes, subsequently developed stage 4A retinal detachment in 1 eye for which they underwent LSV, and maintained complete retinal attachment bilaterally. Eyes that underwent LSV were compared with fellow eyes. Cycloplegic refraction was performed, and corneal curvature, axial length, lens thickness, lens position, and anterior chamber depth were measured. Results: Significantly less myopia was present in eyes that had undergone LSV compared with control eyes (mean spherical equivalent, -6.78 vs -10.33 diopter [D]; P<.001). The reduced myopia in LSV eyes was predominantly owing to increased anterior chamber depth (mean, 3.81 vs 2.96 mm; P<.001) and a more posterior position of the lens (mean, 5.58 vs 4.63 mm; P<.001). There was a minor contribution from reduced corneal power in LSV eyes (mean, 43.90 vs 44.20 D; P=.02). There was no significant difference in axial length, lens thickness, or lens power between LSV and control eyes. Conclusions: Infant eyes undergoing 3-port LSV for stage 4A retinopathy of prematurity develop less myopia than fellow eyes treated with ablative laser alone. The difference is owing to posterior displacement of the lens, with a smaller contribution from reduced corneal power. The reduction in myopia may explain the excellent functional outcomes following 3-port LSV for stage 4A retinopathy of prematurity.