STRUCTURAL OUTCOME AFTER SURGERY FOR STAGE 5 RETINOPATHY OF PREMATURITY BASED ON THE NEW INTERNATIONAL CLASSIFICATION: ICROP 3.

Purpose: This study investigated the outcomes of vitrectomy for Stage 5 retinopathy of prematurity (ROP) based on the International Classification of Retinopathy of Prematurity third edition, in which Stage 5 ROP is divided into three subgroups.

Methods: Fifty-four eyes of 34 patients with Stage 5 ROP who underwent vitrectomy between 2004 and 2020 were retrospectively analyzed. Data including sex, gestational age and weight at birth, International Classification of Retinopathy of Prematurity 3 subcategories, perioperative use of intravitreal bevacizumab injection and laser photocoagulation, surgical procedure and complications, final retinal reattachment, and follow-up period were collected.

Results: Complete retinal reattachment was achieved in 16 eyes (88.9%) with Stage 5A and 13 eyes (39.4%) with Stage 5B ( P = 0.0003, Wilcoxon rank-sum test). Three patients with Stage 5C were considered inoperable. Postoperative anatomical failure was significantly associated with stage (Stage 5B vs. 5A; odds ratio, 17.986; 95% confidence interval, 3.712-148.502; P = 0.0001, multivariate logistic regression analysis). Intraoperative intravitreal bevacizumab was significantly associated with lower postoperative incidence of vitreous hemorrhage and glaucoma ( P = 0.041, chi-square test).

Conclusion: Staging of preoperative anatomical features based on International Classification of Retinopathy of Prematurity 3 is a useful predictor for final anatomical success. Intraoperative intravitreal bevacizumab might reduce postoperative complication risks.