Despite good peripheral ablation and appropriate screening, some children will progress to retinal detachment. It is important to identify these children, hopefully at the stage 4A retinopathy of prematurity retinal detachment, when the macula is still attached. We have recently found that using lens-sparing vitrectomy, 4A retinal detachment can result in a 90% anatomic reattachment rate of the posterior pole with greater than three years follow-up. These results are much superior to what has been presented in the past using scleral buckling. Scleral buckling, in the age of eyes peripherally ablated with laser treatment has much less of a role, if any role, remaining. In addition to the 90% anatomic success rate of lens-sparing vitrectomy, we now know that these children can achieve visions ranging from 20/20 to 20/200 with an average vision in one series of 20/40.
The technique of lens-sparing vitrectomy includes utilization of two-port
vitrectomy instrumentation and in the module, a copy of the list of instruments
used is available. The technique involves clearing the vitreous attachments
from the ridge extending forward towards the lens, posteriorly towards the disc,
and peripherally towards the ora serrata. Very rarely there are also bands that
extend between the ridge across the center of the eye. These also require
division and removal. The appropriate intervention for 4A vitrectomy is prior
to the folds of retina reaching the lens and prior to the fovea being dragged
into this fold or detached in the posterior pole.
GOAL OF VITREOUS SURGERY IS TO INTERUPT THE TRACTIONAL BANDS
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