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Anatomic and Functional Outcomes of Scleral Buckling Surgery for Advanced Retinopathy of Prematurity: A Systematic
Eleni Kottaridou1, Aikaterini K Seliniotaki2, Asimina Mataftsi2
1Department of Accident and Emergency, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, GBR.
Insights
Scleral buckling surgery helps advanced retinopathy of prematurity (ROP) by reattaching retinas in 65% of cases. While it improves anatomical outcomes, visual results are less favorable, highlighting the need for further research in premature infants.
Area of Science:
- Ophthalmology
- Neonatal Surgery
- Public Health
Background:
- Retinopathy of prematurity (ROP) stages 4 and 5 often necessitate surgical intervention.
- Scleral buckling is a common surgical approach for retinal detachment in advanced ROP.
Purpose of the Study:
- To systematically review and meta-analyze anatomical and visual outcomes of scleral buckling surgery in premature infants with advanced ROP (stages 4 and 5).
Main Methods:
- Systematic literature search in MEDLINE and EMBASE (Jan 2000-July 2024) following PRISMA guidelines.
- Single-arm proportional meta-analysis using inverse variance random effects model.
- Protocol registered on PROSPERO (CRD42024557314).
Main Results:
- Ten studies included; pooled retinal reattachment rate (anatomical outcome) was 65% (95% CI [0.49-0.82]).
- Five studies reported visual outcomes; 41% (95% CI [0.29-0.52]) had normal or mild visual impairment (6/18-6/60).
- Follow-up duration varied from 1 to 88 months.
Conclusions:
- Scleral buckling surgery is effective in mitigating retinal detachment progression in advanced ROP.
- Anatomical outcomes are more favorable than visual outcomes following this procedure.
- Further prospective studies with longer follow-up and larger cohorts are recommended.
Abstract:
A significant percentage of patients with retinopathy of prematurity (ROP) who progressed to stages 4 and 5 of ROP will require surgical intervention. Scleral buckling surgery is widely employed for the restoration of retinal detachment in advanced cases of ROP. This systematic review and meta-analysis aim to review the anatomical and visual outcomes following scleral buckling surgery in ROP of stages 4 and 5. We performed a systematic literature search in two databases (MEDLINE and EMBASE), according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, from January 2000 to July 2024 for studies examining the anatomical and functional outcomes resulting from the scleral buckling procedure in premature infants with advanced ROP. We used the inverse variance random effects model to calculate pooled effect estimates and conducted a single-arm proportional meta-analysis. The study was conducted based on a prespecified protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with registration number CRD42024557314. Ten eligible studies for our systematic review were identified. The pooled prevalence for the anatomic outcome, that is the proportion of retinal reattachment, was estimated at 65% (95% Cl [0.49 - 0.82], p-value 0 < 0.0001). The visual outcome was investigated through five studies. The prevalence of normal visual acuity or mild visual impairment, defined as visual acuity between 6/18 and 6/60 as per the World Health Organisation (WHO) visual impairment recommendations, was calculated at 41% (95% Cl [0.29; 0.52], p-value < 0.0001, I2 =0.02%). The follow-up period ranged between one month and 88 months across all studies. Scleral buckling surgery contributes to the mitigation of the progression of retinal detachment in premature infants afflicted with advanced ROP. The anatomical outcomes demonstrate more favourable results in comparison to visual outcomes. Future prospective studies with extended and explicit follow-up periods and larger populations would significantly enhance the existing body of knowledge in this field.
