A systematic review of anatomical and visual function outcomes in preterm infants after scleral buckle and vitrectomy...

This article is a systematic review of the literature examining the anatomical and visual function outcomes after scleral buckle and/or vitrectomy for Stage 4 or 5 retinopathy of prematurity.

The literature published between 1994 through May 2003 was reviewed via a computer search accessing MEDLINE via OVID. Eight applicable studies were retrieved and analyzed. The study designs were descriptive, retrospective, non-comparative, consecutive case series.

The postoperative anatomical outcomes varied dramatically between studies with retinal reattachment rates of 0.8% to 90%. Surgeries that achieved a 50% or higher rate of reattachment occurred primarily between 2 and 9 months of age. Surgeries that occurred between 7 and 11 months of age achieved a lower percentage of retinal reattachment. Further, the longer the duration of follow-up, the lower the percentage of retinas that remained attached. Most importantly, at least in these reports, the degree of retinal reattachment did not correlate well with the level of visual function. One report demonstrated no statistical correlation between visual and anatomical success. Poor visual outcomes were noted in both timely and delayed cases of surgical reattachment of the retina. Many of the reports described challenges in accurately measuring low levels of vision.