Surgical Intervention after Retinal Detachment
Scleral buckling and vitrectomy are last efforts to preserve vision in infants with Stage 4 or 5 ROP, even though visual prognosis is extremely poor. The optimal outcome attained with these surgical interventions is light/darkness or ambulatory vision. Despite poor visual prognosis, some ophthalmologists advocate surgical intervention as a means of preserving the integrity of the retina in the possibility that it may benefit from future technology. Retinal breaks and vitreous hemorrhages are important factors in surgical failure. The decision to perform vitrectomy versus scleral buckle varies among ophthalmologists. Currently, vitrectomy is more widely reported.[35,36,37,38]
Scleral buckling is the traditional method for correction of retinal detachment with ROP in Stage 4. Scleral buckling involves first treating the eye with cryotherapy or laser and then sewing a silicone sponge over the retinal tear. The sponge pushes the sclera toward the retina and holds it in place until scar tissue has time to form. The disadvantage of scleral buckling is that the buckle needs to be released several months after treatment to allow for eye growth. Scleral buckling has an extremely poor prognosis in preserving useful vision.
Vitrectomy is a technique whereby the eye is surgically opened, the lens and vitreous are removed, and scar tissue is excised. This allows the retina to lie against the pigmented epithelium and reattach. Once total retinal detachment has occurred, vitrectomy has been successful in anatomic reattachment in a few cases. Visual outcomes remain poor.
NAINR. 2003;3(3) © 2003 W.B. Saunders
Cite this: Does My Child Really Need to Wear These Glasses? A Review of Retinopathy of Prematurity and Long-Term Outcomes - Medscape - Sep 01, 2003.