Figure 1.

Fundus photographs illustrating immediate sequential bilateral vitreoretinal surgery (ISBVS) for infants with retinopathy of prematurity (ROP). A, B, Premature infant born at 25 weeks gestational age (GA) with a birth weight (BW) of 528 g who demonstrated type 1 ROP and underwent laser photocoagulation at 35 weeks postmenstrual age. The retinopathy continued to progress to stage 4A in both eyes 2 weeks subsequently, and the patient was referred for surgical treatment. Immediate sequential bilateral vitreoretinal surgery was recommended because of bilateral progressive retinopathy in both eyes in an infant with multiple comorbidities, including severe bronchopulmonary dysplasia, intraventricular hemorrhage, and anemia, placing him at high anesthesia risk. Twenty-five–gauge lens-sparing vitrectomy was performed in both eyes. The right eye underwent surgery first, and the left eye was prepared and draped as an independent procedure, using new instruments and intraocular fluids from different lot numbers. Total surgical time was 85 minutes, and time under anesthesia was 113 minutes. There were no ocular or systemic intraoperative or postoperative adverse events. C, D, A premature infant born at 24 weeks GA with a BW of 590 g progressed to stage 4B ROP in the right eye and stage 4A ROP in the left eye, despite 2 rounds of photocoagulation, and was referred for surgical treatment. This infant’s comorbidities included subarachnoid hemorrhage, bronchopulmonary dysplasia, apnea, anemia, patent ductus arteriosus, cirrhosis, and necrotizing enterocolitis. Twenty-five–gauge lens-sparing ISBVS was performed with the same precautions as the first patient without any ocular or systemic adverse events. Total surgical time was 121 minutes, and time under anesthesia was 155 minutes.