Outcomes of primary scleral buckling for stage 4 retinopathy of prematurity

Background: Scleral buckling is an option for stage 4 retinopathy of prematurity (ROP). This study evaluated the anatomic results of a primary scleral buckling procedure for the treatment of this condition. Methods: Retrospective analysis of cases in which premature infants were treated solely with a primary scleral buckling procedure for stage 4 ROP by I retinal specialist between January 1990 and April 2001. The 20 eyes, of 14 infants, had previously been treated with cryotherapy or laser photocoagulation ablation for threshold ROP, but stage 4 ROP had developed. Maintenance of an attached macula was the desired anatomic result of surgical treatment. Results: Of the 20 eyes, 14 (70%) had an attached macula postoperatively. During a follow-up period of 3.5 to 28 months the retina redetached in 2 eyes, which became phthisical. The other 6 eyes also became phthisical, despite additional surgical treatment. Interpretation: Primary scleral buckling has a high anatomic success rate in infants with stage 4 ROP, a rate thought to be higher than would occur with natural progression of the disease. Because an attached macula is associated with improved visual potential, timely primary scleral buckling is reasonable for these infants, offering a 60% chance of useful vision.