Waiting is worthwhile: ROP stage 5 with stage regression due to retinal reattachment after scleral buckling surgery (encircling band) – a case report with review of the literature

Retinopathy of Prematurity (ROP) can progress despite standard treatments such as laser coagulation and VEGF inhibitors. Scleral buckle surgery (SBS) is a surgical option in stage 4 ROP, though anatomical success in stage 5 is rare. We present a unique case of spontaneous retinal reattachment after SBS in stage 5 ROP without further intervention. A female infant, born at 24 + 2 weeks and weighing 440 g, developed stage III ROP with plus disease in the left eye. Despite laser treatment, the disease progressed to stage 4B, prompting SBS at 39 weeks PMA. Within three weeks, the eye advanced to stage 5 ROP. Surprisingly, complete retinal re-attachment occurred spontaneously within four months. Although the anatomical outcome was favorable, the left eye developed high myopia and amblyopia. This case highlights the potential for spontaneous improvement after SBS in advanced ROP. While anatomical success is possible, functional outcomes may remain poor. Individualized follow-up and further research on subretinal fluid dynamics are needed to optimize treatment strategies.