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Scleral buckling surgery for active stage 4A retinopathy of prematurity
B J Hinz1, E de Juan, M X Repka
1Vitreoretinal Service, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-9009, USA.
Insights
Scleral buckling surgery effectively reattaches retinas in stage 4A retinopathy of prematurity, preventing further detachment progression. This treatment offers a promising surgical option for managing this serious condition.
Area of Science:
- Ophthalmology
- Neonatal care
- Surgical innovation
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Stage 4A ROP involves significant retinal detachment, posing a high risk of vision loss.
- Previous treatments like cryotherapy or laser may not halt disease progression.
Observation:
- This study evaluated scleral buckling surgery in eight eyes with active stage 4A ROP.
- Most infants had undergone prior peripheral ablation without success.
- Scleral buckling was performed by a single surgeon, with outcomes assessed over 23 months.
Findings:
- Scleral buckling achieved complete retinal reattachment in 75% of eyes after one procedure.
- Two eyes progressed to stage 4B but were successfully treated with vitrectomy, lensectomy, and membrane peeling.
- The surgery appeared to prevent further retinal detachment progression.
Implications:
- Scleral buckling is an effective surgical intervention for stage 4A retinopathy of prematurity.
- The procedure may reduce vitreoretinal traction and prevent retinal ischemia, altering disease progression.
- Further research into surgical techniques for ROP is warranted.
Objective:
To examine the effectiveness of scleral buckling surgery for active stage 4A retinopathy of prematurity.
Design:
Retrospective noncomparative case series.
Participants:
Eight eyes of seven infants were examined. All except one had previous peripheral ablation (cryotherapy-laser) but retinal detachment was actively progressing.
Intervention:
Scleral buckling surgery was performed by one surgeon.
Main Outcome Measures:
Anatomic retinal status and visual acuity outcome after average follow-up of 23 months were measured.
Results:
Six (75%) of eight eyes had a complete retinal reattachment (+/- macular ectopia) after a single buckling procedure. Two eyes progressed to stage 4B despite scleral buckling but after closed limbal vitrectomy with lensectomy and membrane peeling, the retinas were reattached.
Conclusions:
Scleral buckling for stage 4A retinopathy of prematurity is an effective means of preventing further progression of retinal detachment. The authors believe that the effect of the buckle not only relieves vitreoretinal traction but also plays a role in preventing ischemia in the detached retina that alters the natural progression of the disease.