Surgical therapy for stage V retinopathy of prematurity. A two-step approach.

Between February 1985 and February 1986, ten eyes from a larger series of infants operated on for stage V retinopathy of prematurity were seen with the open funnel type of retinal detachment and vascularly active eyes. We have developed a technique for these eyes involving two-step treatment. The first step is cryotherapy to the avascular peripheral retina which rarely detaches, even in stage V retinopathy of prematurity, followed by lensectomy, vitrectomy and membrane peeling. This technique has allowed us to operate on these ten eyes much earlier than would generally have been possible if the eyes were allowed to become vascularly inactive on their own. We were able to achieve anatomic reattachment of zone 1 as described in the International Classification of Retinopathy of Prematurity in 80% of these eyes. Light perception or better visual function was achieved in 70%, with 30% of the eyes capable of grasping brightly colored unlit objects of 1 in. (2.5 cm) in diameter. This represents a marked improvement in both anatomic and visual results. We feel that this improvement is due to the earlier treatment by lensectomy, vitrectomy and membrane peeling seemingly allowed by pretreating with cryotherapy. In addition, close attention was paid to the refractive status in visual stimulation during the postoperative period.