Kychenthal Andrés, Dorta Paola
Hospital de Niños Roberto del Río, Santiago, Chile.
Retina. 2008 Mar;28(3 Suppl):S65-8. doi: 10.1097/IAE.0b013e318159ec49.
To evaluate the feasibility of performing lens-sparing vitrectomies using 25-gauge instruments for the management of stage 4A retinal detachments in Retinopathy of Prematurity (ROP).
13 eyes of 10 patients with stage 4A retinal detachments underwent a lens-sparing pars plicata vitrectomy. All patients were operated using a three port transconjunctival 25-gauge sutureless technique. The sclerotomies were made 0.5 to 1.0 mm posterior to the limbus through the pars plicata. Core vitrectomy and membrane peeling were performed. A partial fluid-air exchange was used at the end of the procedure in the majority of the cases. The anatomic status of the retina was determined by ophthalmoscopy during routine follow up visits or under general anesthesia. Per-operative complications were recorded.
Eight of the infants were female and two were male. The average postmenstrual age at birth was 26.4 weeks and the average postgestational age at time of surgery was 39.3 weeks (range, 33-44). Three out of the 13 eyes (23%) had zone I ROP. With a mean follow-up of 17 months (range, 4-36) 12 out of the 13 eyes (92%) achieved successful retinal reattachment. One eye developed post operative hypotony with a small choroidal detachment that resolved spontaneously.
Surgical intervention with a three port 25-gauge transconjunctival sutureless vitrectomy is an effective technique to attach the retina in patients with stage 4A retinal detachment in ROP.
评估使用25G器械行保留晶状体玻璃体切除术治疗早产儿视网膜病变（ROP）4A期视网膜脱离的可行性。
10例患有4A期视网膜脱离的患者共13只眼接受了保留晶状体的睫状体扁平部玻璃体切除术。所有患者均采用三通道经结膜25G无缝合技术进行手术。巩膜切口在角膜缘后0.5至1.0mm处，经睫状体扁平部制作。进行了核心玻璃体切除术和膜剥除术。大多数病例在手术结束时进行了部分液气交换。在常规随访或全身麻醉下通过检眼镜检查确定视网膜的解剖状态。记录术中并发症。
婴儿中8例为女性，2例为男性。出生时平均孕龄为26.4周，手术时平均孕周为39.3周（范围33 - 44周）。13只眼中有3只（23%）患有I区ROP。平均随访17个月（范围4 - 36个月），13只眼中有12只（92%）实现了视网膜成功复位。1只眼术后出现低眼压伴小脉络膜脱离，后自行消退。
采用三通道25G经结膜无缝合玻璃体切除术进行手术干预，是治疗ROP 4A期视网膜脱离患者视网膜复位的有效技术。
