Vitrectomy and Scleral Buckling Surgery
Eyes with stage 4 ROP (progressive, active-phase ROP) require surgical intervention using scleral buckling or a lens-sparing vitrectomy to alleviate the vitreoretinal traction causing retinal detachment. Eyes undergoing surgical intervention at stage 4A—rather than at later stages 4B or 5—have more favorable outcomes. Lens-sparing vitrectomy for stage 4A ROP may reduce the progression to stages 4B and 5 ROP; given the improved visual outcome, this is the preferred approach. New microincisional instrumentation is available to facilitate surgery in the smaller-sized infant eyes.
For eyes with stage 5 disease, vitrectomy combined with dissection of the fibrovascular membranes and adherent vitreous has been successful in fully or partially reattaching the retina in approximately 30% of eyes (Video 8-2). Nevertheless, only 25% of retinas in eyes with initial partial or total reattachment after surgery remained fully attached a median of 5 years later. Among the patients whose retinas were initially reattached, only 10% eventually have ambulatory vision. If a drainage retinotomy is performed or an iatrogenic retinal break occurs during a vitrectomy for ROP, the prognosis for that eye becomes uniformly poor.
Stage 5 ROP surgery.
Courtesy of Audina M. Berrocal, MD.
Capone A Jr, Trese MT. Lens-sparing vitreous surgery for tractional stage 4A retinopathy of prematurity retinal detachments. Ophthalmology. 2001;108(11):2068–2070.
Quinn GE, Dobson V, Barr CC, et al. Visual acuity of eyes after vitrectomy for retinopathy of prematurity: follow-up at 5 1/2 years. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology. 1996;103(4):595–600.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.