Introduction: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide.
Areas covered: Recent methods to identify and manage treatment-warranted vascularly active ROP are recognized and being compared to standard care by laser treatment in prospective large-scale clinical studies. Pharmacologic anti-angiogenic (anti-VEGF) treatment has changed the natural history of vascularly active ROP by reducing stage 3 intravitreal neovascularization and extending physiologic retinal vascularization in many infants. Tractional retinal detachments in stage 4 ROP after treatment with anti-VEGF agents show additional fibrovascular complexity compared to eyes treated with laser only. We review current management and outcomes for vascularly active and fibrovascular retinal detachment in ROP (stages 3, 4, 5 ROP), highlighting the evidence from recent clinical studies. Included are technical details important in surgery for retinal detachment in ROP. Literature searches were employed through PubMed.
Expert opinion: Methods in pediatric imaging, safer pharmacologic treatments, and surgical techniques continue to advance to improve future ROP outcomes.
Keywords: angiogenesis; laser; lens-sparing; retinal detachment; retinopathy of prematurity (ROP); scleral buckle; stage 4 or 5 ROP; surgical outcomes; vascular endothelial growth factor inhibitors (anti-VEGF); vitrectomy.