Lens-sparing Vitrectomy for Stage 4 and Stage 5 Retinopathy of Prematurity Young Suk Yu, MD1,2, Seong-Joon Kim, MD1,2, So Young Kim, MD 3 , 4 5 Won Heo, MD4 Ho Kyung Choung, MD , Gyu Hyung Park, MD , Jang Department of Ophthalmology, Seoul National University College of Medicine1, Seoul, Korea Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute2, Seoul, Korea 3 Department of Ophthalmology, Soonchunhyang University Chunan Hospital , Chunan, Korea Department of Ophthalmology, Boramae City Hospital4, Seoul, Korea Department of Ophthalmology, Seoul National University Bundang Hospital5, Sungnam, Korea Purpose: To describe the results of lens-sparing vitrectomy for the correction of retinal detachment associated with retinopathy of prematurity (ROP) and its associated complications. Methods: Seventeen patients who underwent a lens-sparing vitrectomy for stage 4 and stage 5 ROP with plus disease at Seoul National University Children? s Hospital between 1999 and 2003 were enrolled in this study. The patients who had bilateral retinal detachment of ROP underwent a lens-sparing vitrectomy in one eye and a scleral buckling surgery or lensectomy-vitrectomy in the other eye. The patients who had a retinal detachment in one eye and a regressed ROP in the other eye underwent unilateral lens-sparing vitrectomies. A review of their preoperative clinical findings (including the status of retinal detachment and plus disease), post-operative results, and any complications encountered was performed. Results: In 17 patients, the postoperative success rate of lens-sparing vitrectomy was 58.8%. However, lens-sparing vitrectomy as a treatment for stage 5 ROP (25.0%) produced more negative post-operative results than it did when used to treat either those for stage 4a (75,0%) or 4b (66.7%) ROP. Among the 10 eyes in which the retina was attached, form vision was shown in six eyes, light could be followed by three eyes, and no light perception was present in one eye. Intra- and post-operative complications included retinal break formation, cataracts, vitreous hemorrhages, and glaucoma in patients with stages 4b and stage 5 ROP. Conclusions: Lens-sparing vitrectomy resulted in encouraging surgical outcomes in the correction of retinal detachment of ROP, especially in stage 4 patients. Therefore, a lens-sparing vitrectomy for stage 4 ROP patient may be beneficial, although it is still associated with some intra- and post-operative complications. Korean Journal of Ophthalmology 20(2):113-117, 2006 Key Words: Lens-sparing vitrectomy, Retinal detachment, Retinopathy of prematurity Treatments for retinopathy of prematurity (ROP) include laser photocoagulation or cryotherapy (CRYO) for threshold ROP1,2 and scleral buckling surgery3-6 or vitrectomy7-12 for ROP-associated retinal detachment. The CRYO-ROP study revealed the beneficial effects of cryotherapy when used as a treatment for threshold ROP.2,13 Laser photocoagulation to the avascular retina of threshold ROP eyes proved to be just as effective (or even more effective) as cryotherapy.1 Some eyes exhibiting retinal detachment, whether they had been treated or not, required scleral buckling surgery or vitrectomy. Received: November 3, 2005 Accepted: February 9, 2006 Reprint requests to Young Suk Yu, MD. Department of Ophthalmo- logy, Seoul National University College of Medicine, #28 Yeongeon- dong, Jongro-gu, Seoul 110-744, Korea. Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: ysyu@snu.ac.kr The type of surgery depended on the extent of retinal detachment. Scleral buckling surgery for active stage 4 ROP has beneficial effects including the relief of vitreoretinal traction and the prevention of ischemia in the detached retina, which alters the natural progression of the disease.4 However, this may not apply in stage 4 and stage 5 zone I ROP due to posterior tractional retinal detachment.14,15 Although the current standard treatment is the lens-sparing vitrectomy or lensectomy-vitrectomy, surgical outcomes in cases of stage 5 ROP are not satisfactory.16-18 The visual results achieved are low and disappointing9,12,18-21 or they present form- identification vision.10,17,22 There is still controversy concerning when surgery for stage 4 ROP should be performed and which surgical techniques have the most beneficial effects in stage 4 and stage 5 ROP.23 113