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Rare and severe complications following surgical treatment of retinopathy of prematurity according to the vitrectomy method – case report

Abstract Introduction: Retinopathy of preterm infants is a serious condition that can lead to various complications, such as severe vision loss, blindness, and other sequelae of progressive disease in premature infants. In this paper, we report the complication of ciliary body hernias resulting from high intraocular pressure in the afflicted eye combined with secondary glaucoma after vitrectomy due to retinopathy of prematurity (ROP), a condition previously not described in the literature (PubMed or Google Scholar from 2014–2022). Material and methods: The infant underwent photocoagulation treatment twice due to ROP due to ROP stage 4/5. At 4th months of life, the baby underwent posterior vitrectomy with lensectomy, with the final injection of sodium hyaluronate to the vitreous chamber. The child did not suffer from any autoimmune diseases or keratitis. The only risk factors included photocoagulation and vitrectomy with the reconstruction of both the anterior chambers and the pupil. Results: Following posterior vitrectomy, the child manifested multiple complications, such as hernia of the ciliary body, secondary glaucoma, leucoma, hemorrhage to the anterior eye chamber, keratomalacia, and advanced keratopathy. Autoimmune diseases, avitaminosis, the inflammatory of the cornea (of no iatrogenic etiology) and viral or bacterial infections were excluded. Nevertheless, positive bacterial cultures from natural body orifices obtained in routine examinations during hospitalization could cause a severe course of ROP as well as complicated outcomes of surgical treatment. Conclusions: Vitrectomy is the last resort therapeutic option (ROP stage 4A, 4B, 5), as it might result in keratopathy, cataract, glaucoma, strabismus, or severe hyperopia. Due to severe damage to the eye structures that may occur after surgical vitrectomy in premature infants in the course of ROP, this technique should only be used by experienced vitrectomists with great care and caution, especially in extremely low-birthweight children.