04 December 2007

Adult surgical techniques fail again in Late ROP

I get a variation of this story a few times every year and I do not know how to improve the situation.  Therefore I posted my surgical approach for this problem.  The surgeons are generally excellent, but they fall into the same old trap of doing adult surgery on ROP combined rhegmatogenous and traction retina detachment.  It often fails.  The mother gave me permision to post her email.

 Dear Dr. Shapiro,
I am interested in finding out whether there are any experimental treatments being done to regenerate retinal growth in children. 
I am the parent of a ten year old boy with retinopathy of prematurity.  My son has stage 5 (left eye) and 4B (right eye) ROP.  He had unsuccessful surgery on his left eye when he was a baby and this eye has a complete retinal detachment and is blind.  His right eye had a sclera buckle placed on it when he was a baby.  This buckle was removed 3 months later.   Although the macula was dragged and the retina had a fold in it, my son has had a visual acuity of about 20/200 in the right eye for the last ten years.  He functioned very visually and was able to read large print.  3 months ago, the retina in his right eye began to detach.  Our regular retinal specialist was on holiday so a doctor who was unfamiliar with how much useful vision my son had performed an emergency vitrectomy and lensectomy.  He then placed an oil and a capsule in my son's eye.   The plan was to remove the oil in several months, place a bubble in the eye, eventually replace the lens and hope the vision would return.  The macula had not detached at the time of surgery.  About six weeks after this surgery, I noticed that my son seemed to be having more difficulty navigating around.  I took him in for a check up and was told that the capsule was clouded due to the oil and the doctor scheduled the next surgery.  We waited 3 more weeks and went to have the oil removed and the bubble placed.  Things at this point did not go as planned, however.  The doctor discovered that the retina had attached itself to the capsule and this had caused it to pull away and detach.  Without any consultation with me, he went ahead and removed about 50% of my son's retina and put in a heavy oil.  As a result, my son can see some colors and movement but does not have any fine vision.  At my request, we were sent to my son's regular retinal specialist to see if anything more could be done for my son.  This doctor said that he would only ever remove any part of a child's retina as a very last resort.  He is now planning to put a sclera buckle on my son's eye and to replace the oil with one that is more commonly used in children.  The prognosis is very uncertain at this point.  I am wondering if this would indeed be the best course of action at this time and if there is any research being done that might provide some hope for restoring at least some of my son's vision in the future.  
Thank you so much for taking the time to help.

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