Long-term anatomical and visual outcomes following scleral buckling for stage 4 retinopathy of prematurity: Revisiting the basics.

PURPOSE: The management of stage 4 retinopathy of prematurity (ROP) appears complicated and challenging. This study aims to evaluate the possible role of scleral buckling in managing retinal detachment in stage 4 ROP. MATERIALS AND METHODS: This was a retrospective interventional study over 6 years, conducted in southern India. It includes 13 eyes of 11 infants who underwent scleral buckling surgery after being diagnosed with stage 4 ROP. As an institutional protocol, a 240 silicone band was used in all the cases. Patients were followed regularly at the Institute, and when adequate retinal reattachment was achieved, the scleral buckle was removed. RESULTS: Ten eyes were diagnosed with ROP stage 4A (76.92%) and the remainder stage 4B (23.08%). On presentation, the mean gestational age was 39.92±3.71 weeks, and mean weight was measured at 2527.73±536.87grams. The mean age at the time of scleral buckling surgery was 44.77±4.82 weeks gestation. In terms of anatomical outcomes, 12 out of 13 eyes (92.3%) achieved complete retinal reattachment with regression of neovascularization. One case worsened with further progression of neovascularization and a closing funnel retinal detachment. The cases were followed up for a median period of 17.91±8.24 months. In terms of functional outcomes, 5 of the infants (45.45%) were able to fix and follow objects, and 3 (23.08%) were able to pick up objects. One infant who underwent bilateral surgery gained BCVA 6/18 OD and 6/36 OS on the Snellen chart. CONCLUSION: Silicone scleral buckling can be considered as an effective surgical option for managing challenging scenarios in stage 4 ROP.