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ROPARD Online Education Section Module 3
Module 3 – Stage 4A Retinopathy of
Prematurity
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.
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