Abstract
To determine the efficacy of scleral buckling in eyes with stage 4A and 4B retinopathy of prematurity (ROP). Seven eyes of five premature infants underwent scleral buckling for stage 4 ROP in zone II. Five eyes had stage 4A ROP, and two eyes had stage 4B ROP. Six eyes had previous diode laser photocoagulation, and one eye had received an intravitreal ranibizumab injection. Scleral buckling was the procedure of choice due to lack of access to specialized pediatric vitrectomy instrumentation. Average age at surgery was 3.4months. Postoperative anatomic retinal status, visual acuity outcome and refractive error were assessed. The scleral buckle was removed on average 8months after surgery. Retinal reattachment was achieved in all seven eyes. At final follow-up one eye had macular ectopia and disc dragging, one eye had a macular traction fold and two eyes had optic disc pallor. Average myopic error after buckle removal was -7.5 D. Scleral buckling can be performed safely and effectively in 4A and 4B stage ROP in critically ill infants, when access to specialized pediatric vitrectomy instrumentation is limited. This surgical technique may provide adequate relief of vitreoretinal traction with improved visual potential.
Highlights
The advances in neonatal care and the increase in survival rates for extremely preterm babies are steadily raising the number of retinopathy of prematurity (ROP) treatments and the need to manage more advanced stages of the disease [1, 2]
Various surgical techniques have been employed for the treatment of retinal detachments associated with ROP, including scleral buckling (SB), open-sky vitrectomy, vitrectomy and lensectomy, and lens-sparing vitrectomy (LSV) [4]
SB surgery has been the conventional treatment of eyes with stage 4A and 4B ROP, and the mechanism of action has been the relief of vitreoretinal traction [5]
Summary
The advances in neonatal care and the increase in survival rates for extremely preterm babies are steadily raising the number of ROP treatments and the need to manage more advanced stages of the disease [1, 2]. Various surgical techniques have been employed for the treatment of retinal detachments associated with ROP, including scleral buckling (SB), open-sky vitrectomy, vitrectomy and lensectomy, and lens-sparing vitrectomy (LSV) [4]. With the advances in newer microincision vitrectomy instrumentation, better reattachment rates have been reported for LSV compared to SB, as LSV relieves vitreoretinal traction by eliminating the scaffolding for further fibrovascular growth and removes growth factors that contribute to vascular activity [6, 7]. The absence of induced myopia and the avoidance of a second procedure to remove the buckle have established LSV as the procedure of choice for stage 4 tractional retinal detachments associated to ROP [7, 8]. Immediate access to facilities for pediatric vitrectomy is not available in all hospitals with neonatal intensive care units (NICUs)
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