25-gauge lens-sparing vitrectomy with dissection of retrolental adhesions on the peripheral retina for familial exudative vitreoretinopathy in infants

Cyanoacrylate glue for iatrogenic retinal breaks during vitrectomy in stage 5 familial exudative vitreoretinopathy

Purpose

To describe the role of cyanoacrylate glue in sealing iatrogenic retinal breaks (IRBs) during vitrectomy in stage 5 familial exudative vitreoretinopathy (FEVR) with funneled retinal detachment (RD).

Methods

Nine eyes of nine patients diagnosed as stage 5 FEVR were treated with cyanoacrylate glue for IRBs during vitrectomy from July 2020 to January 2022. The clinical records, including patient information, surgical process, and follow-up examinations, were collected retrospectively. Anatomical outcomes and visual outcomes were summarized.

Results

The average age at surgery was 19.6 months (range: 3.8-41.1 months). The mean post-operative follow-up period was 12.5 months (range: 9.8-18.8 months). Before surgery, five eyes had an open-funnel RD and four eyes had a closed-funnel RD. All the preretinal fibroplasia membranes were removed as thoroughly as possible in the nine eyes. IRBs formed at the posterior pole in two eyes and peripheral retina in seven eyes. All the IRBs were sealed successfully by the cyanoacrylate glue when they appeared. At the final post-operative visit, eight eyes had partial retinal reattachment without progression of fibroplasia tissues, while one eye had total retinal redetachment. The rate for stable anatomical outcome was 88.9% (8/9) in this study. The visual testing available for seven eyes demonstrated light perception in five eyes and no light perception in two eyes. No severe perioperative glue-related complications were noted during the follow-ups.

Conclusion

The application of cyanoacrylate glue may be an alternative therapy for IRBs in stage 5 FEVR surgeries, while the long-term efficacy and safety still need further investigation.

Viscodelamination of Localized Retrolental Plaques During Lens-Sparing Vitrectomy in Eyes With Pediatric Tractional Vitreoretinopathy

PURPOSE

To report viscodelamination of localized retrolental plaques during lens-sparing vitrectomy in eyes with pediatric tractional vitreoretinopathy.

METHODS

Viscodelamination of retrolental plaques was performed during 23-gauge lens-sparing vitrectomy in 11 eyes from 11 children with a median age (range) of 12 (4-58) months. There were five eyes with Stage 4 familial exudative vitreoretinopathy, one eye with Stage 4B retinopathy of prematurity, and five eyes with anterior-posterior persistent fetal vasculature syndrome. Retrolental plaques were separated from the posterior lens capsule by the tension of viscoelastic injection in the Berger's space.

RESULTS

In 10 of 11 eyes, retrolental plaques were removed from posterior surface of lens without capsular tearing. During the 12-month to 18-month follow-up period, lens clarity along the visual axis was retained in 5 eyes with familial exudative vitreoretinopathy, one eye with retinopathy of prematurity, and 2 of 5 eyes with persistent fetal vasculature. Atraumatic viscodelamination was associated with retrolental plaques that did not incorporate into the posterior lens capsule. Retinal dragging was reversed in all 11 eyes.

CONCLUSION

Viscodelamination may be effective for the dissection of retrolental plaques related to pediatric vitreoretinopathy in selected cases.

Analysis of Predisposing Clinical Features for Worsening Traction After Treatment of Familial Exudative Vitreoretinopathy in Children

PURPOSE

To determine the incidence of worsening vitreoretinal traction after laser treatment for familial exudative vitreoretinopathy (FEVR) and to determine whether any baseline clinical features are associated with worsening.

DESIGN

Retrospective cohort comparison study in a university tertiary referral center.

METHODS

All patients 0-21 years of age treated with laser from January 1, 2001, to June 1, 2018, were studied. Worsening traction after treatment was defined as the occurrence within 6 months of worsening or development of tractional retinal detachment, folds, dragging, breaks, rhegmatogenous detachment, or worsening tractional membranes. Comparisons of baseline features between groups with and without worsening were performed to determine features associated with higher risk.

RESULTS

A total of 46 eyes from 28 patients met inclusion criteria. Of the 46 eyes, 6 (13%) had worsening after treatment. There were no significant differences in age or other baseline demographics between the cohorts with and those without worsening traction. The presence of proliferative tissue in contact with the lens was found in 2 of 6 patients with worsening compared to 1 of 40 (3%) without worsening (P = .04). Mean follow-up was 57.8 months (range, 6.6-134 months). At the 6-month follow-up, median logMAR visual acuity in the cohorts with and without worsening was 1.7 (Snellen 20/1002; n = 5) and 0.24 (Snellen 20/35; n = 16), respectively.

CONCLUSIONS

Laser treatment resulted in worsening traction in a substantial proportion of eyes with FEVR. Children with proliferative tissue in contact with the lens may be at higher risk of worsening after laser. Potential measures to reduce risk will require further study to establish efficacy.

Bilateral Release of Falciform Retrolental Adhesion by Scleral Buckling in Familial Exudative Vitreoretinopathy

Familial exudative vitreoretinopathy (FEVR) can often present with retinal falciform folds, and rarely with retrolenticular adhesive radial retinal folds. Management of advanced FEVR-associated tractional falciform folds with retrolenticular adhesion to the peripheral retina in the literature has been limited to vitrectomy with or without lensectomy. The authors describe a unique surgical management of a case of bilateral FEVR-associated tractional radial folds with nonaxial retrolenticular adhesion treated with scleral buckling with deferred laser, avoiding the complications associated with vitrectomy and lensectomy on ocular development. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:594-596.].