Encircling scleral buckling as sole therapy for retinal detachment and neovascularization in familial exudative vitreo retinopathy

Abstract

Purpose

Familial exudative vitreoretinopathy (FEVR) is a rare genetic disorder characterized by incomplete retinal vascular development, leading to ischemia, aberrant neovascularization (NV), and retinal detachment (RD). This report describes a case of RD with concurrent NV and FEVR, successfully managed with encircling scleral buckling (SB) surgery without additional peripheral laser ablation.

Case Description

A 16-year-old female with high myopia presented with a four-day history of decreased vision in her right eye (RE). Fundus examination revealed subtotal RD involving the inferior and superonasal quadrants, multiple foci of NV in the inferior quadrant, peripheral avascular retina, and a thick subretinal gliotic band. The left eye (LE) displayed an attached retina with similar peripheral avascularity. Fluorescein angiography confirmed extensive peripheral avascularity and leaking neovascular fronds in the RE, consistent with FEVR. The patient underwent SB surgery in the RE using an encircling band without subretinal fluid drainage or transscleral cryotherapy. Over six weeks, serial examinations demonstrated progressive resolution of subretinal fluid, complete retinal reattachment, and regression of NV in the RE without additional laser treatment.

Conclusion

Early retinal reattachment with SB alone may be sufficient to achieve both anatomical reattachment and regression of NV in selected cases of FEVR-related tractional or rhegmatogenous RD, potentially reducing the need for adjunctive ablative therapy.