Scleral buckling in stage 4A/B retinopathy of prematurity: A retrospective analysis of 105 eyes

PURPOSE: To assess anatomical and functional outcomes of encircling or segmental buckle in premature infants with stage 4 retinopathy of prematurity (ROP). METHODS: This retrospective, single-center, interventional study included preterm infants with stage 4A or 4B ROP who underwent encircling (Group A) or segmental (Group B) scleral buckle. Surgical outcomes, long-term sequelae, and comorbidities were evaluated. RESULTS: A total of 105 eyes (90 infants) were analyzed-85 in Group A and 20 in Group B. Stage 4A was present in 75 eyes. The mean gestational age was 30.05 ± 2.73 weeks; mean birth weight, 1383 ± 411.01 gram. Primary surgical success was 90.5% in Group A (4A: 93.9%; 4B: 78.9%) and 90% in Group B (4A: 88.8%;4B: 90.9%). Preoperative treatment and combined intraoperative interventions significantly improved anatomical success ( P < 0.05). Mean spherical equivalent was -6.00 D in Group A and -3.12 D in Group B. Functional vision (central, steady, maintained) was achieved in 32% of Group A and 55% of Group B. Common sequelae included disc drag and macular ectopia; comorbidities included myopia, strabismus, and nystagmus. CONCLUSION: Scleral buckling is an effective and less invasive treatment for selected cases of stage 4 ROP with peripheral traction.