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R Chandran, MA Worrall, R Sun, WF Mieler, ER Holz; Combined Lens-Sparing Vitrectomy and Scleral Buckling in Stage 4 Retinopathy of Prematurity with Significant Vitreoretinal Traction . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4016.
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Purpose: To assess the efficacy of lens sparing vitrectomy with scleral buckling in reducing the progression to stage 5 ROP in infants with tractional 4A and 4B retinopathy of prematurity (ROP) detachments. Methods: This is a retrospective, non-comparative consecutive case series. The surgical technique consisted of two parts. A solid silicone #240 band was sutured into place at or just anterior to the equator. Three port pars plicata vitrectomy was performed utilizing a lens sparing technique. Core vitrectomy was peformed by removing the vitreous in four planes: ridge to ridge, ridge to periphery, ridge to lens, as well as organized vitreous from the optic nerve head to the ridge. Following vitrectomy, the band was tightened to create a circumferential buckle of moderate height. No intravitreal gas or silicone oil was placed for tamponade. The band was routinely sectioned approximately 3 - 6 months later. Results: 16 eyes of 14 patients underwent lens-sparing vitrectomy with scleral buckling. Six of the infants were female and eight were male. Birth weights ranged from 575 to 1175 g, with an average birth weight of 827 g. The children's gestational ages at birth ranged from 23 to 29 weeks, with an average gestational age of 26 weeks. Age range at the time of surgery was 38-42 weeks. 14/16 eyes had stage 4A ROP, and 2/16 eyes had stage 4B ROP. Overall 15/16 (94%) of eyes were completely reattached with a single surgery. One eye progressed to stage 5 retinal detachment and subsequently failed vitrectomy with lensectomy. At the last examination, 2 of 2 eyes with stage 4B ROP had complete retinal reattachment, and 10 of 11 eyes with stage 4A ROP had complete reattachment. 2 of 13 eyes showed complete retinal reattachment. One eye progressed to stage 5 retinal detachment, and was unable to be reattached after repeat vitreous surgery. No eyes developed rhegmatogenous retinal detachment. Conclusion: In appropriately selected cases of ROP detachment with a significant tractional component, lens-sparing vitrectomy with scleral buckling can be performed safely. This technique, followed by routine sectioning of the buckle approximately 3 - 6 months later, may provide superior anatomic results due to greater relief of traction when compared to scleral buckling or lens sparing vitrectomy alone.
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