Avulsed retinal vessels accompanying posterior vitreous detachment: a late complication of retinopathy of prematurity

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Sir,

Abnormal retinal vasculature and vitreous, in combination with aberrant vitreoretinal traction are factors in the development of late complications in adults with retinopathy of prematurity (ROP).1 A case of intact arcades of retinal blood vessels separated from the retina (see Supplementary movie file), secondary to posterior vitreous detachment (PVD) in an adult with ROP is presented. We wish to highlight this rare late complication of ROP, which was described in adults by Tasman2 in 1970 and in neonates by Kingham3 in 1982.

Case report

A 59-year-old woman attended eye casualty 6 months after uncomplicated cataract surgery with a 1-day history of floaters in her right eye, She was a high myope with a history of ROP (twin birth, 10 weeks premature). In the past, she had suffered from recurrent vitreous haemorrhage in this eye. The left eye was phthiscal as a result of endophthalmitis after cataract surgery.

On examination, the right eye was pseudophakic with visual acuity of 6/9. Fundoscopy showed the optic disc and retinal blood vessels dragged nasally (Figure 1a). In the peripheral fundus, there was chorioretinal atrophy and a falciform fold. A PVD accompanied by intact avulsed retinal vessels floating freely in the vitreous cavity was present (Figure 1b). She had no retinal tear or detachment. OCT demonstrated areas of retinoschisis. Following review by the vitreoretinal team, a policy of observation was adopted. To date her visual acuity is 6/9, with no retinal detachment.

Figure 1
figure1

(a) A nasally dragged disc and retinal vessels. (b) Intact avulsed retinal vessels floating freely in the vitreous cavity.

Comment

Various vitreoretinal complications have been described in the ‘Boomer ROP’ generation (born between 1940 and 1980).4 Premature newborn survival improved during this time, but no defined treatment protocol was available for ROP giving rise to adult patients with various late-onset fundus findings. These include dragging of the retina, retinal detachment, retinal folds, lattice-like degeneration,4 non-neovascular vitreous haemorrhage,5 and myopia.4

Occasionally elevated blood vessels have been demonstrated secondary to vitreous traction.6 We postulate that in this case separation of intact retinal vascular arcades from the retina occurred because of antero–posterior mechanical forces on already dragged retinal vessels under tension when PVD occurred. Kingham also advocated conservative management for such cases.

References

  1. 1

    Shaikh S, Trese MT . New Insights into progressive visual loss in adult retinopathy of prematurity. Arch Ophthalmol 2004; 122 (3): 404–406.

  2. 2

    Tasman W . Vitreoretinal changes in cicatrical retrolental fibroplasias. Trans Am Ophthalmol soc 1970; 68: 548–594.

  3. 3

    Kingham JD . Acute retrolental fibroplasia. II. Treatment by cryosurgery. Arch Ophthalmol 1978; 96 (11): 2049–2053.

  4. 4

    Smith BT, Tasman WS, Young TL, Wilson ME, Raab EL, Paysse EA et al. Retinopathy of prematurity: late complications in the baby boomer generation (1946–1964). Trans Am Ophthalmol Soc 2005; 103: 225–234.

  5. 5

    Quiram PA, Capone Jr A . Adult ROP: late complications of retinopathy of prematurity. Retinal Physician 2007; 4 (5): 25–28.

  6. 6

    Tasman W, Brown GC . Progressive visual loss in adults with retinopathy of prematurity (ROP). Trans Am Ophthalmol Soc 1988; 86: 367–379.

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Correspondence to S Tarafdar.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on Eye website

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