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Benjamin Thomas, Yoshihiro Yonekawa, Michael Thomas Trese; Lens-sparing vitrectomy for Stage 4A retinopathy of prematurity with retrolental adhesions: surgical technique and 15-year follow-up. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):987.
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Retinal folds with retrolental adhesions in Stage 4 and 5 retinopathy of prematurity (ROP) are often associated with lens disruption and poor visual outcomes. We report a technique for addressing these folds during lens-sparing vitrectomy (LSV).
We reviewed the technique employed by one of the authors (MTT) for addressing retrolental membranes adherent to peripheral retinal folds in cases of ROP. Additionally, the 15-year follow-up data from a single case illustrating this technique were reviewed.
During LSV, a microvitreoretinal (MVR) blade passed through a pars plicata surgical entry site can be used to incise retrolental membranes adherent to peripheral retinal folds by making a central puncture site, then sweeping cleanly along the full extent of the membrane. This technique can be performed without damage to the lens or subsequent cataract formation. 15-year follow-up of a case of Stage 4A ROP that underwent LSV with this technique reveals a best correct visual acuity (BCVA) of 20/60 in the affected eye, complete resolution of the retinal fold, no cataract formation, and a stable peripheral retrolental plaque.
Retinal folds with retrolental adhesions are often associated with poor anatomic and visual outcomes in ROP, leading some to advocate for lensectomy in these cases. Contrary to these opinions, we present a straightforward surgical technique that allows for preservation of the lens, full resolution of the retinal fold, and good long-term visual outcomes. Incorporation of this technique into LSV for select patients may offer improved long-term outcomes in these difficult cases.
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