title: Modified 23-gauge vitrectomy system for stage 4 retinopathy of prematurity.
abstract: OBJECTIVE
  To evaluate the outcome of a novel, modified 23-gauge vitrectomy system in the treatment of stage 4 retinal detachment in retinopathy of prematurity.
  
  
  METHODS
  Consecutive patients with stage 4 retinopathy of prematurity treated with modified 23-gauge vitrectomy were included in this medical record review. Major novel modifications included the use of a small infusion cannula, a 20-gauge blade for the creation of sclerotomies in the pars plicata, and a 23-gauge endoilluminator and vitreous cutter. Conjunctival dissection and suturing of sclerotomies were performed using this modified 3-port, 23-gauge vitrectomy technique. Anatomic success and surgical complications were analyzed.
  
  
  RESULTS
  Twenty-six eyes of 17 patients were included and analyzed. The mean (SD) gestational age was 28.0 (2.5) weeks, and the mean birth weight was 1199 (449) g. Mean postmenstrual age at the time of vitrectomy was 40.5 (3.0) weeks. Overall, 20 eyes (77%) achieved retinal attachment in a single operation, and 23 eyes (88%) achieved retinal attachment after multiple procedures. Postoperative complications included disc dragging (5 eyes [19%]), cataracts (4 [15%]), glaucoma (2 [8%]), persistent vitreous hemorrhage (1 [4%]), and posterior synechia (1 [4%]).
  
  
  CONCLUSIONS
  This 23-gauge vitrectomy system seems to be a safe and effective approach for treatment of stage 4 retinopathy of prematurity. This modified system combines the benefits of 20- and 23-gauge vitrectomy and offers safer insertion of infusion cannulas in smaller eyes, more working space in pediatric eyes, a cutting port that is closer to the retina, and a faster cutting speed with less vitreous traction during the operation.
authors: Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. weichi666@gmail.com
authors: Wei-Chi
authors: WC
authors: Wu
authors: Chi-Chun
authors: CC
authors: Lai
authors: Rey-In
authors: RI
authors: Lin
authors: Nan-Kai
authors: NK
authors: Wang
authors: An-Ning
authors: AN
authors: Chao
authors: Kuan-Jen
authors: KJ
authors: Chen
authors: Tun-Lu
authors: TL
authors: Chen
authors: Yih-Shiou
authors: YS
authors: Hwang
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000068258:Bevacizumab; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D012163:Retinal Detachment / Q000601:surgery*; D012178:Retinopathy of Prematurity / Q000145:classification / Q000601:surgery*; D012599:Sclerostomy; D013536:Suture Techniques; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014821:Vitrectomy / Q000295:instrumentation / Q000379:methods*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab