GLAUCOMA IN THE CHILDREN PRESENTING WITH STAGES IV AND V OF RETINOPATHY OF PREMATURITY: THE PECULIAR FEATURES OF THE TREATMENT AND OUTCOMES
Purpose. The objective of the present work was to study the specific features and the effectiveness of the management of glaucoma in the children presenting with stages IV and V of retinopathy of prematurity after vitreoretinal surgical treatment of retinal detachment. Material and Methods. A total of 172 patients (299 eyes) with stages IVa, IVb, and V of retinopathy of prematurity were involved in the prospective cohort study after they had undergone the vitreoretinal surgical intervention for the treatment of retinal detachment. The duration of the follow-up period was 5 years. The treatment of glaucoma included cyclophotocoagulation and the implantation of the Ahmed glaucoma valve drainage. Results. In the early postoperative period, the anatomical success of the surgical treatment of retinal detachment at stages IVa and IVb of the retinopathy of prematurity was estimated at 95,3% and 97,1% respectively; the frequency of smoothing out of the retina associated with the formation of the retinal reattachment zones at stage V of the disease amounted to 63.6%. The frequency of the development of glaucoma was estimated to be 24,0% at stage IVa, 18,3% at stage IVb, and 9,2% at stage V. The clinical manifestations of glaucoma developing at stage IVa retinopathy of prematurity were especially well apparent in the patients with the congenital disease. The secondary neovascular glaucoma without buphthalmos was usually associated with stages IVb and V of retinopathy of prematurity. The effectiveness of cyclophotocoagulation efficacy was estimated to be 36,4% at stage IVa compared with 50,0% and 57,3% at stages IVb and V respectively. The implantation of the Ahmed glaucoma valve drainage proved efficient in 9 out of the 10 cases; still 77.8% of the patients needed a repeated revision for the evaluation of the state of the Ahmed valve drainage. The study has demonstrated that the overall success of the glaucoma treatment in the children presenting with stages IVa retinopathy of prematurity was 100% compared with 3.5% and 33.3% in those with stages IVb and V of the disease respectively. Conclusion. The glaucoma developing in the children with stages IV and V of retinopathy of prematurity is a refractory neovascular condition especially if it is associated with stages IVb and V of the primary disease.