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 ± 536.87 grams. 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.