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Purpose of the study To examine the cause of treatment failures in Type 1 retinopathy of prematurity (ROP). Patients and methods The medical charts of all infants with disease persistence after laser treatment at Uppsala University Hospital, Sweden, during a 10-year period (2009-2019) were reviewed. RetCam photography and angiography were used to document the retinal appearance before and after retreatment. Results Ten infants (18 eyes), of whom nine were referred from other hospitals, had persistence of Type 1 ROP in zone I or zone II despite previous laser treatment. Their mean gestational age was 24 weeks and their mean birth weight was 618 g. Seven eyes were diagnosed as stage 3 plus, eight eyes as stage 4A and three eyes as stage 4B. In eight infants (14 eyes), inadequate laser coagulation was suspected to be the cause for persistence of type 1 disease. Two infants (four eyes) were appreciated to have persistence of plus disease because of presence of zone I disease. For persistence of Type 1 ROP, five infants (seven eyes) were treated with vitrectomy, two infants (three eyes) with laser photocoagulation and anti-vascular endothelial growth factor (VEGF), two infants (four eyes) with anti-VEGF alone and finally two infants (four eyes) with laser photocoagulation alone. The anatomical outcome was good in 14 eyes and poor in four eyes (three infants). Conclusions Inadequate laser coagulation is an important cause of treatment failure of ROP Type 1. Another cause is laser coagulation in zone I. To minimize remaining visual disability, some kind of centralization of the ROP treatment is suggested.

If a complication such as posterior capsular defect occurs (Fig. 3.1), the following procedure is recommended

The following chapter describes the management of a dropped nucleus. Two surgical methods are described: The extraction of the luxated nuport trocar system with chandelier light cleus with fragmatome and luxation of the nucleus into the anterior chamber with PFCL.

The following chapter reports step-by step the surgical procedure of a dislocated IOL. The surgery for a partially subluxated and a completely luxated IOL is described.

Cortical fragments may dislocate into the Berger space in an uneventful cataract surgery or during a posterior capsular rupture. This chapter reports about the surgical management of dislocated cortical fragments from pars plana.

This chapter shows a check list for trocar surgery of posterior segment and reports about possible indications for trocar surgery of posterior segment. All surgeries can be performed with a phacoemulsification machine.

This chapter gives an introduction to trocar surgery and shows what surgeries can be performed with this new technique.

The following chapter describes step-by-step the fundamentals of pars plana vitrectomy. Several drawings are included.

This chapter reports about the surgical management of posterior capsular opacification from pars plana.

This chapter reports about the surgical technique of IOL implantation in eyes with posterior capsular rent.

The following chapter shows step-by-step the SICS surgery. SICS stands for Small Incision Cataract Surgery and should not be confused with MICS (=Minimal Incision Cataract Surgery). SICS is a modified ECCE and has been developed in India. SICS is the most common technique for cataract surgery today.

This chapter reports about the Surgical management of a dislocated IOL with retropupillar Artisan implantation.

This chapter reports about the surgical management of positive vitreous pressure during cataract surgery.

This chapter is about recurrence of ROP after anti-VEGF treatment. The clinical course and timing of recurrence after anti-VEGF treatment is clarified. Furthermore, major clinical studies about the incidence of recurrence after anti-VEGF treatment for ROP are summarized.

This chapter is about the dose of anti-VEGF injection in infants. The most recent studies regarding the dose of bevacizumab (Avastin) and ranibizumab (Lucentis) for ROP are summarized.

This chapter compares laser coagulation with anti-VEGF treatment and shows in detail the advantages and disadvantages of each treatment method.

This chapter shows several case reports about treatment failures of ROP disease from the authors’ clinics.

This chapter is about the technique of lasercoagulation of newborn with Laser Indirect Ophthalmoscopy (LIO). The technique is demonstrated step-by-step and illustrated by many drawings and pictures.

This chapter is about complications of laser coagulation of newborn. Colour pictures and angiography pictures show in detail examples of eyes with an undertreatment or overtreatment of the retina after laser photocoagulation. An incomplete laser coagulation results often in a progression of the ROP disease and must be avoided.

This chapter is about lens-sparing vitrectomy for ROP disease. First the physiology of a neonate eye, the type of retinal detachment and the timing of surgery is explained and then the surgery is described step-by-step. Several videos are included.

This chapter is about ROP stage 5 retinal detachment. The anatomy and visual outcome of this severe pathology is explained.

This chapter is about a special technique, which allows laser coagulation under guidance of angiography. This technique is required for children where the border between physiologic and pathologic retina cannot be discerned. The technique is again demonstrated step-by-step and illustrated with many pictures.

This chapter is only about retinopathy of prematurity (ROP). It contains a historical introduction about ROP and a short section about pathophysiology of ROP. Next follows a detailed classification of ROP illustrated with many pictures and finally the most recent screening recommendations.

This chapter is about familial exudative vitreoretinopathy. The diagnosis and classification of this hereditary disease is clarified. In addition, fluorescein angiography findings and OCT features are demonstrated and explained.

This chapter is about posterior hyaloid contraction syndrome. This phenomenon occurs after a vitrectomy and is caused by a postoperative posterior vitreous detachment (PVD). The pathology and surgery is described. Videos are included.

This chapter is about the visual outcome of very preterm neonates with ROP at 6.5 years of age. In addition, three clinical cases are reported to show the variety of outcome of this pathology.

This chapter is about recurrence and complications after laser coagulation and anti-VEGF treatment. Recurrence and complications are very different in both treatment modalities and it is very important to know them.

This chapter is about persistence of ROP disease after laser coagulation or anti-VEGF. What to do? In addition, treatment algorithms for ROP 3+ disease for treatment centers as well as for non-treatment centers are displayed and explained.

This chapter is about the technique of anti-VEGF injection. The needle and syringe, the volume of medication and anaesthesia are described. Then how to inject at the bedside and how to inject in the operation room with the microscope are explained in detail. A video is included.

This chapter is about assessment of ROP neonates. The correct assessment of plus disease and of zone I or zone II is crucial for determining the correct timing and choice of treatment.

This chapter contains many case reports about pediatric retinal diseases such as Neurofibromatosis, FEVR, incontinentia pigmenti, Coats and successful ROP cases. Videos are included.

ROP in zone I is very difficult to treat. The conventional treatment modality of laser coagulation results in many recurrences and complications. The author describes very elegant how this problem was approached and solved at his hospital in Korea.

This chapter is about vitrectomy for retinal detachment stage 4A and 4B with fibrovascular membranes. The membranes develop if you wait too long for treatment. The membranes lift up the retina resulting in a tractive retinal detachment. This pathology is surgically very difficult to treat. The surgery is described step-by-step. Videos are included.

This chapter is about angiography of newborn. The technique of angiography with Retcam is described, followed by an angiography atlas with pictures from Retcam and Optos.

The surgical technique of pneumatic retinopexy is described in detail. The surgery is performed with a microscope and a BIOM. An indirect ophthalmoscope is not used.

The following chapter shows step-by-step the surgical technique of a combined scleral buckle and vitrectomy.

In case of gas and silicone oil tamponade, we position the patients for 1 week. In case of 1000 cSt and 5000 cSt silicone oil, we position in the same way as with a gas tamponade. In case of Densiron 68, the patient is advised to sleep on the back (supine) and free positioning under the day.

The following chapter informs about the advantages of a chandelier light. A chandelier light allows bimanual vitrectomy which is required for difficult vitreoretinal surgery. The different chandelier lights are shown in detail and the insertion is demonstrated step-by-step.

An inferior retinal detachment has a frequency of 20% and is more difficult to treat than a superior detachment. Why? Because gas and silicone oil tamponade insufficiently the inferior pole. An exception is the heavy silicone oil Densiron 68 which tamponades the inferior pole. If you do not have Densiron 68 in your surgical cupboard, then you require episcleral buckling with encircling band and/or segmental buckle in your surgical armamentarium.