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R. Chandran, W.F. Mieler, A.R. McPherson, E.R. Holz; Scleral Buckling in Stage 4 Retinopathy of Prematurity with Significant Vitreoretinal Traction . Invest. Ophthalmol. Vis. Sci. 2003;44(13):603.
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Purpose:To assess the efficacy of scleral buckling in reducing the progression to stage 5 ROP in infants with tractional 4A and 4B retinopathy of prematurity (ROP) detachments. Methods:This is a retrospective, non-comparative consecutive case series. The surgical technique consisted of placement of a solid silicone #240 band exoplant, which was sutured into place at the equator, and tied with a #270 sleeve. The band was tightened to create a circumferential buckle of moderate height. No intravitreal gas or air was utilized. The band was routinely sectioned approximately 5 months later. Results: 6 eyes of 6 patients underwent scleral buckling. All six infants were female. Birth weights ranged from 484 to 1077 g, with an average birth weight of 716 g. The gestational ages at birth ranged from 22 to 27 weeks, with an average gestational age of 25 weeks. Age range at the time of surgery was 34-47weeks. 4/6 eyes had stage 4A ROP, and 2/6 eyes had stage 4B ROP. Overall 5/6 (83%) eyes were completely reattached with a single surgery. One 4B eye progressed to stage 5 retinal detachment and subsequently failed vitrectomy with lensectomy. At the last examination, 1 of 2 eyes with stage 4B ROP had complete retinal reattachment, and 4 of 4 eyes with stage 4A ROP had complete reattachment. No eyes developed rhegmatogenous retinal detachment. Conclusions:In appropriately selected cases of stage 4A or 4B ROP detachment a scleral buckle can be performed safely. This technique, followed by routine sectioning of the buckle approximately 5 months later, may provide adequate relief of anterior traction when compared to lens sparing vitrectomy alone.
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