Retinal detachment with macular holes in infants with retinopathy of prematurity

Objective: To describe retinal detachment with macular holes in infants with retinopathy of prematurity and the methods of surgical repair with their outcomes. Methods: A retrospective review of 4 cases of retinopathy of prematurity and 1 case of retinopathy in a full-term infant that resembled retinopathy of prematurity, in which a macular hole and associated retinal detachment developed and surgical repair was attempted. Results: The average gestational age of the 4 infants with retinopathy of prematurity was 26 weeks. All 5 patients had a history of vitreoretinal surgery prior to discovery of the macular hole. All 4 who underwent further surgical correction have partially or completely attached retinas and ambulatory vision. Conclusions: Vitrectomy combined with fluid-air exchange failed to close a macular hole associated with retinal detachment in infants with retinopathy of prematurity. Athermal scleral buckling of the macula can close macular holes and reattach the retina. Scleral buckling appears to be the method of choice for repair.