Vitrectomía en la retinopatía del prematuro avanzada

Abstract

Advanced retinopathy of prematurity (ROP) with tractional retinal detachment is uncommon, highly complex, and potentially devastating to vision. Vitrectomy may provide an opportunity for retinal reattachment and preservation of residual visual function, but outcomes depend on disease stage, vascular activity, detachment configuration, previous treatment, timing of surgery, and team experience. This scientific opinion article integrates the available evidence with the experience of a multidisciplinary group and proposes a practical framework for Argentina. Its central position is that surgery must not replace prevention, screening, or timely treatment of active vascular disease. Progression to stage 4 warrants urgent assessment by a surgeon experienced in pediatric vitreoretinal disease; anatomical and functional outcomes are generally more favorable in stage 4 than in stage 5. Anatomical reattachment does not necessarily translate into visual recovery, particularly in stages 4B and 5. Surgical candidacy should be individualized through comprehensive ophthalmic and systemic assessment, adequate documentation, and shared decision-making with the family. Lifelong follow-up should address recurrent detachment, cataract, glaucoma, refractive error, amblyopia, and strabismus, together with neurodevelopment and the possible coexistence of cerebral visual impairment. Continuity of care, realistic communication, and early visual intervention are inseparable components of management.