A Multidisciplinary Approach in the Management of Aggressive Retinopathy of Prematurity With Bleb-Like Posterior Combined Retinal Detachment

We report two cases of bleb-like combined retinal detachment (BLRD) in infants with aggressive retinopathy of prematurity (A-ROP). Both cases involved premature infants born at 28 weeks of gestation with complex postnatal courses, who were referred to our clinic for ROP management. On presentation, both babies were diagnosed with stage 4B ROP in zone 1 with bilateral BLRD. Indirect ophthalmoscope-guided laser photocoagulation under topical anesthesia was performed on the same day. Pediatric clearance for surgery was obtained. Both infants underwent blood transfusions for anemia. Subsequently, 25-gauge lens-sparing vitrectomy with endolaser and fluid-air exchange was performed in both cases. Postoperative courses were uneventful. Follow-up examinations under anesthesia allowed for laser augmentation in the first case; no additional avascular retina was noted in the second case, and no further laser treatment was applied. At the most recent follow-up, both babies exhibited well-attached retinas with regressing ROP. Refraction was performed, glasses were prescribed, and close monitoring was advised. BLRD in zone 1 ROP presents significant therapeutic challenges. Successful management relies on prompt and coordinated teamwork among ophthalmologists, neonatologists, anesthetists, and opticians. Optimal outcomes depend on maintaining adequate hemoglobin levels, timely surgical management, examinations under anesthesia (EUA), laser augmentation, visual rehabilitation, consistent follow-up, strong parental involvement, and ongoing multidisciplinary collaboration.