Scleral buckling surgery for active stage 4A retinopathy of prematurity

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.