Clinical Features and Surgical Outcomes of Encircling Scleral Buckling With Cryotherapy in Familial Exudative Vitreoretinopathy-Associated Rhegmatogenous Retinal Detachment

Abstract

Purpose: To report the clinical features and surgical outcomes of encircling scleral buckling surgery with cryotherapy in familial exudative vitreoretinopathy (FEVR) patients with rhegmatogenous RD.Methods: This study was a consecutive, retrospective interventional case series. Clinical features, including the FEVR stage, proliferative vitreoretinopathy grade, range of RD and degeneration, and presence of retinal breaks, and surgical outcomes, including the success rate, best-corrected visual acuity, and myopic shift, were analyzed.Results: There were 16 eyes with Stage 3A FEVR and eight eyes with Stage 4A FEVR. 13 eyes had Grade A proliferative vitreoretinopathy, and 11 eyes had Grade B proliferative vitreoretinopathy. Retinal reattachment was achieved in 22 of 24 eyes (91.67%) with FEVRrhegmatogenous RD after initial encircling scleral buckling surgery. The best-corrected visual acuity improved from a mean of 1.08 ± 0.86 logarithm of the minimum angle of resolution preoperatively to 0.45 ± 0.41 logarithm of the minimum angle of resolution postoperatively (P , 0.01). A myopic shift of 22.39 ± 1.38 (range, 21 to 26) diopter (P , 0.01) was observed. The mean follow-up period was 34.5 ± 27.7 (range, 7-104) months.Conclusion: Our study clarified the efficacy of encircling scleral buckling surgery with cryotherapy in FEVR-rhegmatogenous RD with Stage 3A or 4A FEVR and Grade A or B proliferative vitreoretinopathy, especially in patients with multiple retinal holes.RETINA 42:55-63, 2022F amilial exudative vitreoretinopathy (FEVR), a familial disorder characterized by incomplete retinal vascularization, was first described by Crisswick and Schepens in 1969. 1 Retinal detachment (RD) is a serious complication leading to visual disruption that occurs in 21% to 64% of eyes with FEVR. 2 In Eastern countries, FEVR-associated rhegmatogenous RD (FEVR-RRD) is more common than FEVRassociated tractional RD (TRD) or exudative RD. 3 The outcomes of the surgical treatment of FEVR-RRD have been reported, for which segmental scleral buckling (SSB) and vitrectomy with or without scleral buckling are extensively used, depending on the severity of the disease. 4-10 However, the indications for encircling scleral buckling (ESB) surgery have not been further discussed. Therefore, we retrospectively studied the clinical features and surgical outcomes of FEVR-RRD patients who underwent ESB surgery at our hospital. MethodsTwenty-four eyes with FEVR-RRD that underwent ESB surgery performed by experienced vitreoretinal 55

Management and surgical outcomes of pediatric retinal detachment associated with familial exudative vitreoretinopathy – Our experience at a tertiary care ophthalmic center in North India

“…Concurrently, we had a good anatomical success rate too, with 92.85% of eyes having reattachment of the retina. This is in line with Chen et al ,[ 5 ] who too demonstrated excellent retinal reattachment of 95.8% in their series of 24 eyes, and Huang et al ,[ 13 ] who achieved anatomical success in 91.67% of eyes undergoing encircling SB with cryotherapy for FEVR-RRD. In other studies, involving a combination of FEVR-RDs, including TRD, ERD, and RRD, marginally lower reattachment rates have been achieved, including 83.9% by Yamane et al .…”

“…Huang et al . [ 13 ] evaluated the surgical outcomes of eyes with only stage 3A or 4A FEVR that were managed by encircling SB with cryotherapy. In contrast, since the current study included eyes having stage 4A, 4B, and 5A FEVR, the surgical management included both SB and vitrectomy depending upon the clinical profile.…”

“…Additionally, while Huang et al . [ 13 ] included patients with a varied spectrum of age, we evaluated only the pediatric population.…”

Surgical Complications in Retinopathy of Prematurity: Literature Review and Management Strategies

“…2,3,7,[10][11][12][13][14][15][16][17][18] The anatomic success rates of familial exudative vitreoretinopathy-related tractional retinal detachment (TRD) and rhegmatogenous retinal detachment also range from 63% to 96%. [19][20][21][22][23][24] However, anatomic and functional failures increase with higher stages of disease, where the risk for complications may also increase. 16,18,25,26 There is always a risk for complications with any surgery.…”

“…The anatomic success rate of vitrectomy for stage 4A and stage 4B ROP ranges from 82% to 100% and 63% to 92%, respectively 2,3,7,10–18. The anatomic success rates of familial exudative vitreoretinopathy–related tractional retinal detachment (TRD) and rhegmatogenous retinal detachment also range from 63% to 96% 19–24. However, anatomic and functional failures increase with higher stages of disease, where the risk for complications may also increase 16,18,25,26…”