25-Gauge pars plicata vitrectomy for stage 4 and 5 retinopathy of prematurity.

Purpose: To describe the authors' technique and initial experience using the 25-gauge vitrectomy system for stage 4 and 5 tractional retinal detachment in retinopathy of prematurity (ROP).

Methods: Consecutive patients with stage 4 or 5 ROP treated with 25-gauge vitrectomy surgery between July 2003 and May 2004 were studied retrospectively. Eyes with prior vitrectomy surgery were excluded. A modified three-port 25-gauge approach was used in which conjunctival dissection and suturing of sclerotomies was necessary. The primary outcome was anatomic success defined as retinal reattachment. Secondary outcomes were intra- and postoperative complications.

Results: Fifteen eyes in 12 infants were identified that had 25-gauge vitrectomy for stage 4 or 5 ROP: 11/15 (73%) had stage 4A; 2/15 (13%), stage 4B; and 2/15 (13%), stage 5. All 15/15 (100%) were referred with incomplete anterior laser ablation of threshold ROP. Six of 15 (40%) required lensectomy at the time of initial pars plicata vitrectomy. Seven of 15 (47%) required more than one retinal surgery for persistent retinal detachment and/or vitreous hemorrhage. Eleven of 15 (73%) eyes had documented retinal reattachment after one or more surgeries at the last follow-up. Complications included vitreous hemorrhage (2) and postoperative cataract (1).

Conclusions: Twenty-five gauge vitrectomy is a safe and effective treatment approach for tractional retinal detachments in stage 4 and 5 ROP. Complications may be comparable to vitrectomies performed with two-port 20-gauge vitrectomy. Modifications of the 25-gauge vitrectomy system included conjunctival dissection and suturing of conjunctiva and sclerotomies at the conclusion of the case.