Cataract and phthisis bulbi after laser photoablation for threshold retinopathy of prematurity

PURPOSE: To describe the visual and structural outcome of eyes that developed a dense cataract after laser photoablation for threshold retinopathy of prematurity. METHODS: A retrospective review of eight consecutive infants who developed dense cataract(s) after bilateral laser photoablation for threshold retinopathy of prematurity. Of the 10 eyes with cataract, five eyes were treated with a diode laser and five with an argon laser. The stage and zone of the retinopathy of prematurity, number of burns applied, time of onset of the cataract, clinical findings at the time of cataract surgery, and the course after cataract surgery were reviewed. RESULTS: Six eyes had zone 1 disease and four had zone 2 disease. The mean number of burns applied per eye was 2532 +/- 856 (range, 1400 to 4500). A cataract was diagnosed a median of 3 [corrected] weeks (range, 1 to 28 weeks) after laser photoablation. Nine of the 10 cataracts were sufficiently dense to preclude a view of the fundus. All 10 eyes had clinical signs suggestive of an inflammatory or ischemic process that included one or more of the following findings: corneal edema, pupillary membrane, iris atrophy, depigmentation of ciliary processes, pigment on the anterior lens surface, posterior synechiae, hyphema, and shallow anterior chamber. Nine eyes underwent cataract surgery. Five of the 10 eyes had retinal detachment ranging in severity from stage 4A to stage 5 at the time of cataract surgery. Nine of the 10 eyes progressed to phthisis bulbi and no light perception. CONCLUSIONS: A dense cataract developing in the eye of an infant after laser photoablation for threshold retinopathy of prematurity is associated with a poor visual prognosis. The constellation of associated clinical findings appears to be most consistent with anterior segment ischemia.     

Lens-sparing vitreous surgery for infantile amblyogenic vitreous hemorrhage

PURPOSE: To report on a series of infants with amblyogenic vitreous and/or subinternal limiting membrane hemorrhage managed by lens-sparing vitrectomy. DESIGN: Retrospective case series studying retinal attachment status and visual acuity. RESULTS: Eleven eyes sustained vitreous hemorrhage as a consequence of shaken baby syndrome, 1 due to hyaloidal canal hemorrhage extending into the vitreous, 1 due to Terson syndrome, 1 due to birth trauma, and 2 due to a presumed coagulation disorder. Age of the patients at the time of surgery ranged from 2 to 23 months (age adjusted for prematurity). Follow-up ranged from 7 to 81 months (mean, 28 months). Ten eyes had visual improvement. Two infants with shaken baby syndrome had bilateral nonrecordable flash visual evoked potential before surgery; one eye of one infant had a better than expected visual outcome after surgery. One eye sustained a retinal tear without detachment. One eye in an infant with severe shaken baby syndrome and traumatic retinopathy developed a total rhegmatogenous retinal detachment with proliferative vitreoretinopathy. CONCLUSIONS: Infantile amblyogenic vitreous hemorrhage may be effectively managed by lens-sparing vitreous surgery. Visual outcome of shaken baby syndrome may be limited as a consequence of structural damage to the retina, optic nerve, or posterior visual pathways.     

Outcomes after laser therapy for threshold retinopathy of prematurity

OBJECTIVE: To determine the anatomic outcomes of eyes treated with laser photocoagulation for threshold retinopathy of prematurity and to identify potential risk factors for unfavorable outcomes after treatment. DESIGN: Retrospective, noncomparative case series. INTERVENTION: Photocoagulation of the peripheral avascular retina with an argon or diode laser indirect ophthalmoscope. PARTICIPANTS: One hundred twenty eyes of 81 infants with threshold retinopathy of prematurity treated with laser photocoagulation from 1989 through 1997 with at least 12 months of follow-up after treatment. MAIN OUTCOME MEASURES: The principal outcome was the presence of an unfavorable anatomic outcome defined as a retinal detachment, macular fold, or retrolental tissue. RESULTS: One hundred nine of 120 eyes (91%) had favorable outcomes. Eleven eyes (9%) had retinal detachments, and 1 of the 11 also had retrolental tissue. Zone 1 eyes appeared to be 3.3 times more likely to have an unfavorable outcome compared with zone 2 eyes, but the 95% confidence interval (0.8-14.5) did not support this statistically. Twenty-four of 109 eyes (22%) experienced dragging of the temporal vessels. Those with zone 1 disease were 13.7 times more likely to experience temporal dragging compared with zone 2 eyes (95% confidence interval, 3.3-57.2). CONCLUSIONS: After laser photocoagulation for threshold retinopathy of prematurity, 91% of eyes had a favorable anatomic outcome. Compared with zone 2 eyes, zone 1 eyes may be more likely to have temporal dragging of the retinal vessels. Laser therapy is effective in the treatment of threshold retinopathy of prematurity.     

Diode laser photocoagulation to the ridge and avascular retina in threshold retinopathy of prematurity

PURPOSE: To report results applying diode laser photocoagulation to both the peripheral avascular retina and the ridge in stage 3+ threshold retinopathy of prematurity. METHODS: The authors performed a retrospective review of 82 consecutive eyes in 43 preterm infants with threshold disease who had both the peripheral avascular retina and the ridge treated with diode laser photocoagulation. With a minimum follow-up of 3 months, these eyes were evaluated for intraoperative and postoperative complications and long-term anatomic results. RESULTS: A favorable anatomic outcome occurred in 79 eyes (96%). There were no intraoperative complications. Postoperative intraocular hemorrhage occurred in eight eyes (10%) and resolved without sequelae. Supplemental laser was required in only two eyes (2%). CONCLUSIONS: Diode laser photocoagulation to the ridge and peripheral avascular retina in threshold retinopathy of prematurity is associated with a favorable anatomic outcome. The risk of postoperative intraocular hemorrhage and the need for supplemental laser photocoagulation is low.     

Combined treatment with laser photocoagulation and cryotherapy for threshold retinopathy of prematurity

PURPOSE: To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP). METHODS: Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. RESULTS: A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over -6 diopters. CONCLUSIONS: Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.     

Retinopathy of prematurity in practice. II: long-term results following treatment for threshold disease

OBJECTIVE: To determine the long-term outcome of treatment for threshold retinopathy of prematurity (ROP) in one UK unit. METHODS: A total of 35 infants diagnosed with threshold ROP were treated by a single ophthalmologist (DGC) between 1987 and 1998. The parents of the 29 surviving patients were contacted; 21 brought their child for special review of acuity, motility, refraction and fundoscopy (Group 1). Of the eight patients who were unable to attend, six patients (Group 2) had sufficient follow-up detail in their records to be included in the study.RESULTS: A total of 40 eyes in the 21 patients in Group 1 had been treated; 10 had received cryotherapy (eight bilateral) and 11 had bilateral laser. Mean follow-up was 5 years (range 2-12 years). A total of 23 treated eyes (in 16 patients) had an acuity of 6/12+ (57.5% of treated eyes). Four eyes of three patients had no light perception. Seven eyes in four patients had myopia of more than 3 D. Eight patients had a manifest squint: six esotropia, two exotropia. The retinal status of 36 eyes (90%) showed a favourable outcome. The four blind eyes had stage 5 disease. In Group 2, four eyes of two patients (33%) had 6/12+ acuity recorded; five eyes in three patients had stage 5 disease and no perception of light. In total, a favourable structural outcome was achieved in 81.4% and favourable functional outcome observed in 74.6%. CONCLUSION: These results show that the favourable outcomes reported in the CRYO-ROP trial can be achieved in routine practice and maintained after long follow-up.     

Clinical outcome of confluent laser photoablation for retinopathy of prematurity.

PURPOSE: During the past decade, laser photoablation has supplanted cryotherapy as the standard treatment for threshold retinopathy of prematurity (ROP). We evaluated the progression and the complication rate in a cohort of infants with threshold ROP treated with a confluent technique. METHODS: We retrospectively studied 47 patients with ROP (91 eyes), treated with confluent diode laser photoablation. Four main outcomes were evaluated: (1) the rate of progression, (2) the frequency of laser retreatment, (3) postoperative complications, and (4) postoperative refractive error. RESULTS: A mean of 1943 +/- 912 laser burns were administered in a confluent pattern to 91 eyes with threshold ROP. Progression to stage 4 or 5 disease occurred in 13 of 29 eyes (44.8%) with zone I and posterior zone II and in 2 of 51 eyes (3.9%) with anterior zone II ROP (P =.01). Eyes with anterior zone II ROP that received more than or equal to 2000 burns progressed more than those that received fewer than 2000 burns. Only 1 eye (1%) needed a supplemental laser treatment. Postoperative complications included corneal edema (2.3%), anterior segment ischemia (2.3%), vitreous hemorrhage (7.9%), posterior synechiae (2.3%), cataract (4.9%), and macular ectopia (12%).The mean spherical equivalent at the last follow-up was -4.52 +/- 5.63 D. CONCLUSIONS: In our series, infants received more laser burns than infants reported in the literature receiving scatter or near-confluent treatment. While confluent treatment almost eliminated supplemental treatment, it was associated with a similar rate of progression and complications as has been reported with other patterns of laser treatment.     

The outcome of retinopathy of prematurity: screening for retinopathy of prematurity using an outcome predictive program

PURPOSE: The purpose of this study was to compare the calculated risk of progression to threshold retinopathy of prematurity (ROP) and risk of an unfavorable structural outcome using the computer program, RM-ROP, with the observed incidence for infants born at Jackson Memorial Hospital (JMH) and to determine how many children would have been treated unnecessarily if the threshold criteria for treatment were lowered on the basis of the clinical findings and RM-ROP risk calculations. DESIGN: Noncomparative interventional case series. PARTICIPANTS: All 292 surviving premature infants weighing 1250 g or less at birth and born at JMH between January 1, 1997, and December 31, 1998, were included in the study. METHODS: Baseline demographic factors and data from sequential ophthalmic examinations were entered into the RM-ROP program for risk calculation. Infants reaching threshold disease received diode laser indirect photocoagulation of the avascular retina. Three-month follow-up was obtained for infants receiving laser treatment. MAIN OUTCOME MEASURES: The development of threshold ROP and an unfavorable structural outcome, defined as a posterior retinal fold or posterior retinal detachment occurring within 3 months of threshold disease. RESULTS: Thirty-eight eyes were diagnosed with threshold ROP, with 18 of 20 subjects having bilateral disease. Three-month posttreatment follow-up was obtained on all 20 children, with 19 having good structural outcomes. Thirty-two percent of eyes (12 of 38) reaching threshold never had a risk estimate greater than 0.10. However, only 6% of eyes (35 of 546) that did not reach threshold ever had a model predicted risk greater than 0.15. All right eyes with zone 1 prethreshold disease, 60% of those with zone 2 stage 2+ disease, and 23% with zone 2 stage 3 disease progressed to threshold ROP. CONCLUSIONS: The similarity between the risk distributions for the Miami and the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study indicates the similarity in the populations with respect to risk factors identified as important by the model. The Miami data validated the model, with eyes reaching threshold having higher risks than eyes that did not. Actual risk estimates for eyes reaching threshold can be small. Changing the threshold criteria for treatment on the basis of various clinical and computer-generated prethreshold risk levels in our population would have resulted in the unnecessary treatment of many infants who never progressed to threshold disease. In the Miami population, if the model were used to manage an individual subject, close attention would have to be paid to small differences in risk. Although the RM-ROP software program may be a useful tool for following premature infants with ROP, the clinical examination remains the "gold standard."     

Trends in the management of stage 3 retinopathy of prematurity.

AIMS/BACKGROUND: The clinical outcome of 66 consecutive infants with stage 3 retinopathy of prematurity (ROP) is reported. METHODS: Thirty four infants (64 eyes) were treated with cryotherapy and 32 infants (59 eyes) underwent laser photocoagulation. RESULTS: Infants with anterior-mid zone II ROP had a high rate of disease regression whether treated by cryotherapy or laser photocoagulation. Infants with posterior zone II or zone I ROP had a 40% success rate with cryotherapy, and 87.5% when treated with laser photocoagulation. CONCLUSION: Evolving experience and changing management policies in infants with posterior ROP has led to improved results.     

Long-term stability and visual outcome after favorable initial response of proliferative diabetic retinopathy to panretinal photocoagulation

The authors assessed the relationship between early objective response to panretinal photocoagulation (PRP) and the subsequent long-term visual outcome in 59 eyes of 59 consecutive patients who developed proliferative diabetic retinopathy while under the care of a retinal specialist. Thirty five eyes (59%) had regression of high-risk retinopathy characteristics within 3 months of treatment. Eighteen of these eyes (52%) had a final visual acuity of 20/20 or better with a mean follow-up of more than 4 years. Only 2 of the 24 nonresponder eyes (8%) had visual acuity of 20/20 or better. Thirteen of the responder eyes (37%) sustained a delayed vitreous hemorrhage, which was usually self-limited. Three responders underwent vitrectomy with excellent visual results. The authors conclude that the beneficial effect of PRP on visual outcome is directly related to the regression of retinopathy risk factors and that the long-term visual prognosis in high-risk eyes manifesting a favorable initial response to PRP is excellent.     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

Laser photocoagulation (810 nm diode) for threshold retinopathy of prematurity: a prospective randomized pilot study of treatment to ridge and avascular retina versus avascular retina alone

The purpose of this study was to compare the structural outcome of laser treatment to avascular retina and ridge versus laser treatment to avascular retina alone in cases with threshold retinopathy of prematurity (ROP). A prospective, randomized, interventional, comparative study of consecutive cases referred to a single tertiary center was considered here. 50 infants with bilateral symmetrical threshold ROP were recruited into this study over a period of 3 years. Threshold ROP was defined as per CRYO-ROP study. Perinatal history details for all patients including significant maternal history were recorded. One eye of each patient was randomized (Microsoft Excel 2000) to one of the two treatment groups—laser treatment to avascular retina (Group A) or laser treatment to avascular retina and ridge (Group B). Laser treatment was performed with a 810 nm diode laser (Iris Medical Instruments, Inc. Mountain View, CA, USA). Treatment was continued until regression of ROP. Structural outcome was assessed at a minimum follow-up of 6 months and was considered favorable or unfavorable as per the CRYO-ROP study criteria. An unfavorable outcome consisted of either (1) a retinal fold involving the macula; (2) any retinal detachment involving zone 1; or (3) a retrolental mass that obscured visualization of the posterior pole. Secondary outcome measures included the difference in time to regression of ROP and complications of treatment between the two treatment groups. 100 eyes of 50 infants received laser photocoagulation for threshold ROP after randomization (50 eyes in each group). Of these 50 infants, 20 (40%) were female and 30 (60%) were male. A significant proportion of the children (46%) were conceived as twins. The average birth weight was 1360 ± 326 g (range 750−2200 g). The mean gestational age at birth was 30.72 ± 1.6 weeks (range 26−36 weeks). Zone I disease was present in 14 (14%) eyes and zone II in the remaining 86 eyes (86%). Threshold stage retinopathy (CRYO-ROP criteria) extending 360° (12 clock hours) was present in 21 infants (42%), 5 contiguous clock hours of stage 3+ in 14 infants (28%) and intermediate range in the remaining 15 infants (30%). At 6 months follow-up, 3 eyes (6%) in group A and 1 eye (2%) in group B had an adverse structural outcome; however, the time to regression of retinopathy 2.98 ± 1.5 weeks in group A and 3.12 ± 1.1 in group B (P = 0.889) and the rate of complications such as retinal hemorrhage, 3 eyes in group A and 4 eyes in group B, was comparable. Zone I eyes showed equal incidence of favorable anatomical outcome (85.7%) in each group. Laser treatment to ridge was found to be safe and effective in the treatment of threshold ROP in this short-term pilot study; however, it needs to be ascertained whether this treatment has long-term advantages over conventional laser treatment to avascular retina, as well as the long-term benefits of treatment to ridge.     

Natural history of retinopathy of prematurity.

Sixty-nine infants at risk of developing retinopathy of prematurity (ROP) were entered into a prospective study to assess the incidence and natural history of the disease. Seventeen infants developed ROP, and in six eyes the disease progressed to stage IV ROP. The natural regression of a pupillary membrane and physiological vitreous haze was not influenced by the onset of ROP. Progression from stage I to stage III was rapid and the rate was influenced by the zone affected. Congestion and tortuosity of vessels in the posterior pole always signified stage III ROP. Progression from stage III to stage IV ROP was slower; it was characterised by the development of vitreoretinopathy, signified by the sudden onset of a vitreous haze. Iris congestion associated with poor mydriasis may be a grave sign indicating imminent retinal detachment. Cicatricial ROP can be divided into retinal and vitreoretinal cicatricial disease directly related to the stage of active disease reached. ROP is characterised by its self limiting nature, but the stage at which it becomes inactive varies and will influence the final outcome.     

Advanced cicatricial retinopathy of prematurity--outcome and complications.

AIMS: To assess the outcome and complications of patients with advanced retinopathy of prematurity (ROP). METHODS: All patients with eyes achieving stage 4 or 5 retinopathy of prematurity were reviewed. Twenty one eyes were diagnosed during ROP screening in maternity hospitals and 10 eyes were of infants transferred for treatment. RESULTS: Thirty one eyes of 17 patients were included. Thirteen eyes were treated for acute disease but progressed to stage 4 or 5; seven had cryotherapy and six diode laser photocoagulation. Cataract was found in 17 eyes (54.8%), glaucoma in seven eyes (22.6%), microphthalmos in 15 (48.4%), and corneal opacification in four eyes (12.9%). Fifteen eyes had surgical procedures; two (6.5%) had trabeculectomy, four (12.9%) had lensectomy, and nine (29%) retinal detachment repair. Transferred infants had their initial eye examination later than infants in hospitals screened by the authors and 80% of them had progressed beyond threshold ROP by the time they were transferred for treatment. Twenty nine eyes (93.6%) had visual acuities of 3/60 or less and only two eyes (6.5%) achieved 6/18 or less. CONCLUSION: The visual outcome of the eyes undergoing retinal re-attachment surgery was disappointing. Cataract, microphthalmos, and glaucoma were the most frequent complications, and surgical intervention was often required. The need for children who are blind as a result of ROP to have long term follow up is shown.     

Advanced retinopathy of prematurity. The anatomic and visual results of vitreous surgery

The anatomic and visual results of vitreous surgery in 140 eyes of 108 children with stage 4 and 5 retinopathy of prematurity (ROP) were reviewed. Macular attachment was achieved in 9 (64%) of 14 eyes with stage 4. In stage 5 eyes, partial posterior attachment was obtained in 38 (31%) of 121 eyes and complete posterior attachment was obtained in 11 eyes (9%). Final visual acuity of fix and follow or greater occurred in 6 (43%) of 14 eyes with stage 4 and in 13 eyes (11%) with stage 5 ROP. Retinal detachment (RD) funnel configurations were classified according to the International Committee on ROP. The funnel type which was wide anteriorly and wide posteriorly had the best anatomic (63%) and visual (19%) success. Reoperation rarely improved visual acuity (4%), although reattachment was possible in 6 (22%) of 27 eyes. All children in this series underwent surgery by 2 years of age. Anatomic and visual success was achieved less often in children who underwent surgery at age 6 months or younger.     

Cataract surgery in children with and without retinopathy of prematurity

PURPOSE: To report the outcomes of cataract surgery in children born prematurely who had or did not have retinopathy of prematurity (ROP). SETTING: Seoul National University Hospital, Department of Ophthalmology, Seoul, Korea. METHODS: Retrospective studies were conducted by reviewing the charts of 26 eyes of 14 premature infants with or without ROP that had cataract surgery. The patients' preoperative characteristics and postoperative visual outcomes were documented. Cataract surgery consisted of lensectomy, posterior capsulectomy, and anterior vitrectomy in patients younger than 2 years and primary posterior chamber intraocular lens (PC IOL) implantation or secondary PC IOL implantation in those 2 years or older. Postoperative optical correction in those younger than 2 years was by glasses or contact lenses. RESULTS: Eight eyes of 5 patients had acute ROP; 4 eyes had stage 3, 2 had stage 2, and 2 had stage 1. Three eyes had transconjunctival cryotherapy for treatment of threshold ROP. First-eye cataract surgery were performed in children from 0.2 to 5.5 years old (mean 1.5 years) and second-eye surgery, in children from 1.8 to 12.1 years old (mean 4.3 years). Twenty eyes had implantation of a PC IOL. In 1 patient with stage 3+ ROP, Rush (plus) type, both eyes had combined cataract and scleral buckle encircling surgery. The mean follow-up after the last surgery was 1.4 years (0.5 to 3.1 years). At the last examination, the best corrected visual acuity was good fixation or better than 20/80 except in 2 eyes, 1 with esotropia and the other with a dense pupillary membrane. CONCLUSIONS: This is the first report of an encouraging surgical outcome for PC IOL implantation in premature infants with cataract regardless of the presence of ROP. However, if retinopathy is present and has progressed in the cataractous eye of a premature child, careful examination and timely surgical decisions are important.     

Schwellenwert-Frühgeborenen-Retinopathie

BACKGROUND: The results of the Cryo-ROP group showed that cryotherapy significantly reduces the rate of adverse morphological and functional outcome of eyes with threshold retinopathy of prematurity. Structural status and visual acuity of 48 eyes which consecutively underwent cryocoagulation in our hospital between 1990 and 1994 were examined at 2 years corrected gestational age. METHOD: Visual acuity and fundus morphology were examined by Teller acuity-cards test, retinoscopy, orthoptic status and fundus examination. A favourable grating acuity was defined as > or = 2.2 cy/degree, a favourable morphology as no pathological or mild findings at the level of the posterior pole or stage 4 a. RESULTS: Fifty-six % of cases reached a quantifiable grating acuity between 0.32 and 13.0 cy/degree, 42% reached a favourable functional outcome, and 69% of the eyes had a morphologically favourable outcome. Fifty-five % of the measurable eyes were myopic, and 29% had a high myopia > or = -6.0 D. 47% showed a heterotropia. CONCLUSIONS: Our results show a discrepancy between morphological and functional outcome. Especially for zone 1 eyes, cryocoagulation of the avascular retina does not seem to allow a favourable morphological and functional outcome.     

Intravitreal pegaptanib combined with diode laser therapy for stage 3+ retinopathy of prematurity in zone I and posterior zone II

Purpose. To investigate efficacy of intravitreal injection of pegaptanib and laser photocoagulation for treatment of stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels, and final structural outcome with conventional laser photocoagulation or combined with cryotherapy. Methods. In a prospective comparative study, 152 eyes with zone I, II posterior ROP 3+ (76 premature rabies), from 2009 to 2011, were included. Patients were randomly assigned to receive intravitreal pegaptanib (Macugen? 0.3 mg = 0.02 mL, Pfizer) with conventional diode laser photocoagulation in group 1 (68 eyes of 34 infants) or only laser therapy combined with cryotherapy in group 2 (84 eyes of 42 infants), bilaterally. The primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP. The mean follow-up after treatment was 19.3 months in group 1 and 21.5 months in group 2. Results. Final favorable anatomic outcome and stable regression of ROP at last control examination was noted in 89.7% of eyes in group 1 and 60.8 % of eyes in group 2. Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in group 1. No recurrence of neovascularization (stage 3+ ROP) was identified in 85.4% of patients in group 1 and 50% of patients in group 2. Conclusions. Results of this study support the administration of intravitreal pegaptanib as useful therapy in the management of stage 3+ ROP.     

A comparison of cryotherapy versus diode laser retinopexy in 100 consecutive infants treated for threshold retinopathy of prematurity

PURPOSE: The purpose of this paper is to present a series of patients who were treated for threshold retinopathy of prematurity with either cryotherapy or diode laser. Complications and unfavorable outcomes during the first year after treatment will be compared for the two procedures. METHODS: The clinical courses of a consecutive series of 100 infants (192 eyes) were reviewed. All infants had their threshold status confirmed by a second examiner. Infants were treated with cryotherapy through 1993 and with diode laser thereafter. One hundred two eyes of 54 patients were treated with cryotherapy. Ninety eyes of 46 patients were treated with laser retinopexy. Two of the patients who were treated with laser (4 eyes) did not survive to the 3-month follow-up visit, and their results are not included here. The two groups of infants were comparable in their birth weight, adjusted gestational age at treatment, and severity of disease as determined by zone and sectors of stage 3 retinopathy of prematurity. RESULTS: Unfavorable outcome (total retinal detachment) was seen in 25.4% of eyes treated with cryotherapy (26 of 102), as compared with 15% of eyes treated with laser (13 of 86). Two cataracts were seen in our patients: one patient 22 weeks after cryotherapy, and the other 7 months after diode laser. CONCLUSIONS: No statistically significant difference was found in the rate of retinal detachments in the two groups (X2 = 3.05; P = .08).