The only surviving twin, a female, was born at 25.5 weeks GA and with a BW of 750 g. She was diagnosed as having stage 4A ROP in the right eye, stage 3 in the left eye, and moderate-plus disease in both eyes at 8 weeks of age. Both eyes had ROP in zone 1. The window for treatment of threshold disease had passed in the right eye. Cryotherapy was performed in the right eye and laser in the left to reduce the neovascular activity. However, the disease progressed to stage 5 bilaterally; the right eye remains detached despite open-sky vitrectomy and currently has NLP visual acuity. Ultrasonography at 23 weeks of age revealed a funnel-shaped total RD with an open-closed configuration in the left eye, at which time open-sky vitrectomy was performed. The retina reattached in the left eye and remained attached until 33 months of age when a shallow RD with preretinal organization and subretinal bands developed. One month later, a total RD developed in the left eye, and a circumferential scleral buckle was placed. The retina was temporarily reattached, but at 38 months of age, the retina was totally detached again with a macular hole and extensive subretinal organization. At this time, a pars plana vitrectomy, membrane peel, and air-fluid exchange were performed to remove the fluid in front of the detached retina. With the retina still detached and subretinal fluid remaining, the macular hole was plugged with cyanoacrylate glue applied directly to the hole in the air-filled vitreous cavity. The retina did not reattach even with drainage of subretinal fluid 1 month later. At 42 months of age, a radial scleral buckle with a sponge No. 506 was used to close the macular hole. No treatment with cryotherapy or laser was applied to the hole (athermal buckle). The retina reattached and the visual acuity was 20/760 (VHD) 1 year and 6 months after the last surgery. The family has since moved, and 9 years after surgery, the local ophthalmologist, who has observed this patient, reports that the cyanoacrylate glue persists and the retina remains attached (Susan G. Elner, MD, written communication, September 2003).