Refractive outcomes of three-port lens-sparing vitrectomy for retinopathy of prematurity (an aos thesis)

Purpose: To study the refractive outcomes of 3-port lens-sparing vitrectomy (LSV) for subtotal retinal detachments due to retinopathy of prematurity (ROP). Lens-sparing vitrectomy may provide superior refractive outcomes by limiting induced myopia of prematurity. Methods: This is a retrospective, consecutive, nonrandomized, comparative (paired eye) study. Entrance criteria were previous complete ablative laser for threshold ROP in both eyes, followed by LSV in one eye for stage 4A traction retinal detachment. Both eyes then maintained complete retinal attachment. Main outcome variables were cycloplegic refraction, keratometry, and biometric values for axial length, lens thickness, and anterior chamber depth. Results: Nine patients met inclusion criteria. Lens-sparing vitrectomy eyes were significantly less myopic than control eyes (-6.78 D vs -10.33 D, P < .005). The reduction in myopia in LSV eyes was predominantly due to increased anterior chamber depth (3.81 mm ± 0.217 vs 2.96 mm ± 0.232, P < .005). There was a minor contribution from reduced corneal power in LSV eyes (43.89 D ± 0.253 vs 44.20 D ± 0.265, P < .005). There was a minor negative impact from increased lens thickness in LSV eyes (3.85 ± 0.32 mm vs 3.74 ± 0.31, P < .005). There was no significant difference in axial length or lens power between the LSV and control groups. Conclusions: The data demonstrate that infant eyes undergoing 3-port LSV for stage 4A ROP develop less myopia than fellow eyes treated with laser alone. The difference is due to posterior displacement of the lens-iris diaphragm with a smaller contribution from reduced corneal power. The reduction in myopia may improve functional outcomes following 3-port LSV for stage 4A ROP.