The analysis of failure diode laser treatment of active phase of retinopathy of prematurity

PURPOSE: The aim of this study was to analyze risk factors influencing diode laser treatment of active phase of retinopathy of prematurity. MATERIALS AND METHODS: 106 premature infants were treated with the use of diode laser at Department of Neonatology since 1.01.2003-30.11.2004. The mean gestational age was 27.3, mean birth weight 1022 g. The earliest age of laser therapy was 37th day of life and the latest one 104th day (mean 64.3 days). 18 neonates were excluded from the study because they were from other departments, and 2 because they died. The results of treatment of the rest 86 children were evaluated. The occurence of retinal detachment or macular ectopy was classified as unfavorable outcome. RESULTS: The complete remission was obtained in 143 eyes (83.2%),the macular ectopy was diagnosed in 10 eyes (5.8%), the retinal detachment in 19 eyes (11%). Children with unfavorable outcomes were divided in two groups. The first one included 6 extremely immature infants, born between 24 to 25th week of gestation. The ROP in this group was diagnosed in I zone with plus disease. The second group included children with gestation age from 28 to 32 Hbd. 9 of them had severe infection (sepsis, congenital pneumonia, urinary tract infection), 1 serious maternal history (R type of diabetes). The procedure of laser therapy was performed on average at 72th day of life at the first group, and at 50th day at the second one. CONCLUSIONS: (1) Important risk factors of treatment failure of active phase of retinopathy of prematurity, is low gestational age and infections which take place in perinatal period. (2) In the second group of infants (gestational age from 28-32 Hbd), with treatment failure the retinopathy of prematurity occured much more earlier then in the group with successful treatment. (3) When making decision of the patient treatment besides estimation of the eye fundus and the progress of changes, we should also consider risk factors which have influence on retinopathy of prematurity, after treatment.     

The results of diode laser treatment of retinopathy of prematurity

PURPOSE: To evaluate the results of diode laser treatment of active phase of retinopathy in prematurity. MATERIAL AND METHODS: We studied 240 premature infants since January 2003 to October 2004. In 60 premature infants (102 eyes--25%) ROP was found. 26 premature infants (52 eyes--43.3%) with threshold ROP (stage 3a) in II zone (12 eyes) and in II and III zone (40 eyes) were treated with an aid of diode laser. Birth weight varied from 650 to 990g (mean 799.23g) and gestational age from 23 to 28 weeks (mean Hbd 26.2). RESULTS: Good anatomical results were obtained in 25 cases (50 eyes--96.15%), in 1 case (2 eyes--3.85%) was total retinal detachment. In this case the progress of retinopathy was caused by small birth weight and other chronic disorders. CONCLUSIONS: Diode laser treatment of active phase of retinopathy in prematurity gives good anatomical results. The results of treatment depend on the other chronic diseases of premature infants.     

Indirect diode laser treatment and cryotherapy in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a major cause of blindness in babies. To explore the incidence, treatment and short-term outcome of the disease in Romania, a small scale study on 24 preterm infants with gestational age < 32 weeks and birthweight < 1500 g was undertaken. Gestational age was < 28 weeks in 66.6% and birthweight was < 1000 g in 70.8% of the children. The average age at the first examination with the indirect ophthalmoscope was 31.8 weeks, only two children having been seen at less than 6 weeks of age. 66.6% of the babies had ROP in various stages with 93.8% of these having bilateral (symmetrical or asymmetrical) abnormalities. 37.5% of the babies with ROP were in stage 5. 12.5% (2 patients) had bilateral threshold disease: one infant was treated with diode laser delivered with the laser indirect ophthalmoscope and the other with cryotherapy. In three eyes of these two infants the disease regressed. No major short term complications were noted and no second session of treatment was necessary. In our patients, the well-recognised correlation between the incidence and severity of the disease and gestational age and, to a lesser extent, birthweight was confirmed. Lack of equipment was the main reason for the delay in diagnosis. The extent of the disease in our patients, in a country where the number of surviving preterm babies is expected to increase in the coming years, warrants the initiation of a national screening programme for retinopathy of prematurity in Romania.     

The results of treatment of retinopathy of prematurity by laser photocoagulation

PURPOSE: The subject of paper was to assess: 1. The child's age, when the threshold retinopathy is diagnosed. 2. To estimate the correlation between gestational, corrected and chronological age of the child at the time of the ophthalmologic surgery. 3. To estimate the effect of the treatment on the ROP's regress and to find the risk factors of the progress of retinopathy despite of the treatment. MATERIAL AND METHODS: We studied 103 children treated because of the retinopathy of prematurity. The mean chronological age at the time of the surgery was 74,8 day +/- 18,3 and corrected age was 37,7 Hbd +/- 3,2. To assess the risk factors of the progress of the ROP despite the treatment we formed the group I- 57 children with the retinopathy's regress after the surgery and group II- 23 children with unfavorable outcome of the disease (i. e. partial or complete retinal detachment at least unilaterally). RESULTS: Fetal age correlated with corrected age at the time of the surgery (r=0,57, p<0,0001) and there was a negative correlation between gestational and chronological age at the time of the surgery (r = -0,23, p=0,02). Statistical significance was achieved by the stage of ROP before the surgery and the effects of the treatment (chi2=43,8, p<0,0001). CONCLUSIONS: The risk of the threshold retinopathy before 36 week of corrected age increases with decreased gestational age. There is positive correlation between corrected age and gestational age. The laser photocoagulation performed in appropriate time stops progression of ROP. The photocoagulation of the retinopathy is a very important risk factor of the severe vision impairment when it is made too late (more than 3rd stage of ROP). The progress of ROP despite of laser therapy is more likely in the most premature babies with small weight gain.     

The natural history of active retinopathy of prematurity

Two hundred twenty-one premature infants were examined in the premature nursery. Thirty-seven of the 221 (16.2%) had retinopathy of prematurity (ROP). Eight patients (21.5%) went blind and three other infants lost sight in one eye for a total of 19 sightless eyes (25.7%). The remaining 55 eyes (74.3%) retained vision. Birth weight was the most critical prognostic factor. Of eight babies who became blind all were under 1000 grams at birth, while babies who showed little change from active ROP were generally over 1300 grams. Nine of 14 eyes with only peripheral shunts (64%) resolved without dragging of the retina in the posterior pole. Sixteen eyes developed peripheral retinal detachment, and six of the sixteen (37.4%) had associated dilation and tortuosity of vessels in the posterior pole. Only one of these eyes resolved with minimal sequelae, suggesting that peripheral retinal detachment with dilated tortuous vessels was the most significant indicator of serious consequences.     

Treating retinopathy of prematurity with laser diode photocoagulation

AIM: The purpose of the study was to assess the outcomes of the diode laser in the treatment of retinopathy of prematurity and to discuss the up-to-date possibilities of treating of active phase of this disease. MATERIAL AND METHODS: 96 children (185 eyes) treated with diode laser retinal photocoagulation for active stage 3 of ROP in our department in years 1996-2000. RESULTS: Favorable structural outcome was observed in 83.8% of treated eyes. In the remaining eyes the disease progressed despite of the treatment and falciform retinal fold (5.4%), partial retinal detachment (6.5%) and total retinal detachment (4.3%) developed. No serious complications were observed after the treatment. CONCLUSIONS: Diode laser retinal photocoagulation is a safe and effective procedure for treating active stage 3 of retinopathy of prematurity. It has been especially useful for treatment of changes in zone 1 and 2 of the disease. Diode laser photocoagulation is now the preferred method of treating active stage 3 of ROP in our department.     

Cryotherapy for active retinopathy of prematurity

Twenty-eight patients with bilateral symmetrical Stage 3 retinopathy of prematurity (ROP) and plus disease had one eye assigned to cryotherapy and the other to control. The majority of patients weighed under 1000 grams at birth and females outnumbered males by nearly a two-to-one ratio.+ Cryotherapy was generally performed at a gestational age of less than 40 weeks and a mean chronologic age of 10 weeks. Eleven patients showed improvement in both the treated and untreated eyes possibly due to variables among prematures not identified in the study. Eleven other patients experienced improvement in the treated eye and progression in the untreated eye. Using the binomial distribution on the latter group the P value was 0.0005 with a one-tailed hypothesis test and 0.001 with a two-tailed test, suggesting that in the sampled population cryotherapy appears to be preferred over no treatment.     

Cryotherapy for active retinopathy of prematurity

Twenty-eight patients with bilateral symmetrical stage-III retinopathy of prematurity and plus disease had one eye treated using cryotherapy, while the other acted as a control. Eleven patients showed improvement in both the treated and untreated eye, while 11 others were noted to improve in the treated eye while demonstrating deterioration in the untreated eye. The P value obtained by applying binomial distribution tests suggested that, in the sampled population, cryotherapy was preferable to no treatment.     

Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser

PURPOSE: To evaluate the safety and efficacy of sub-Tenon's local anaesthesia (LA) for laser treatment of threshold retinopathy of prematurity (ROP).METHODS: A cohort of 18 eyes of 10 neonates with threshold ROP was treated with diode laser peripheral retinal ablation over 14 treatment sessions using oral sedation and sub-Tenon's anaesthesia. Treatment was performed in a neonatal unit. The heart and respiratory rate, trans-cutaneous oxygen saturation, and physical activity were continuously monitored for signs of neonatal distress. Cardio-respiratory stability during and after the procedure was scored for each eye treated using a Cardio-respiratory index described previously.RESULTS: In all cases, the planned dose of laser was delivered. One out of 18 eyes developed stage 4b tractional retinal detachment over a follow-up of at least 6 months for all babies. Systemic complications during treatment included transient bradycardia and apnoea requiring stimulation in two babies and excessive head mobility in three babies. Treatment duration varied between 20 and 80 min. Ocular complications were conjunctival haemorrhage and chemosis. The mean cardio-respiratory index was 1.13, which compared favourably with the standard published.CONCLUSIONS: Sub-Tenon's LA with oral sedation appears to be a safe and effective alternative to general anaesthesia for laser treatment of ROP, with the potential for lower morbidity.     

早产儿视网膜病变筛查和阈值期治疗的研究

目的研究早产儿视网膜病变(ROP)的发生率,评估ROP阈值期治疗效果。方法使用双目间接检眼镜对108例早产儿进行ROP筛查,将筛查结果进行统计学分析,达到阈值病变的患儿及时进行视网膜激光光凝或经巩膜、视网膜冷凝术。结果筛查108例早产儿,发现ROP23例,发生率为21.3%。在所有ROP患儿中,ROP1期13例,占56.5%;ROP2期3例,占13.0%;ROP3期7例,占30.4%。其中ROP3期患儿均伴有附加病变,达到阈值病变标准。ROP患儿出生体重为(1.43±0.25)kg(t=4.059,P<0.001);孕周为(31.0±2.3)周(t=2.637,P=0.013);吸氧时间为1~49d,平均17d(n=23,Z=-3.630,P<0.001);需要机械辅助呼吸患儿18例(χ2=12.009,P=0.001);上述指标与非ROP患儿比较,差异均有统计学意义;而与是否多胎的差异无统计学意义(χ2=1.013,P=0.314)。Logistic回归分析:出生体重低(β=-2.542,OR=0.079,P=0.032)和使用机械辅助呼吸(β=1.341,OR=3.823,P=0.025)的患儿是发生ROP的相关高危因素。7例阈值期病变患儿中,6例进行激光光凝或冷凝治疗。术后随访2个月至2年,手术眼的结构和视功能未见异常。1例阈值期病变患儿未予治疗,于1个月后出现视网膜脱离。结论出生体重轻、孕周少、吸氧时间长、需要机械辅助呼吸的早产儿发生ROP的风险较高。对阈值期病变患儿应及时进行激光光凝或冷凝治疗。     

Pharmacological treatment for retinopathy of prematurity

Mandatory screening performed by an experience ophthalmologist remains the most important pillar in the management of retinopathy of prematurity (ROP). The current gold standard for treatment of proliferative ROP is still panretinal laser photocoagulation, depending on severity, in combination with vitreoretinal surgery if necessary. The first case series of off-label intravitreal anti-VEGF treatment are encouraging. In addition to intravitreal anti-VEGF therapy, other treatment concepts such as supplementation with IGF-1 or omega-3 fatty acids also represent interesting pharmacological approaches to the management of ROP. However, larger controlled trials are required to validate the benefits and safety of these systemic treatment approaches.     

早产儿视网膜病变的筛查分析

Objective To investigate the incidence of retinopathy of prematurity(ROP)in Dongguan People's Hospital. Methods Records of premature infants who had undergone ROP screening in our hospital between June 2009 and October 2010 were analyzed retrospectively. Results Twenty-one cases out of 126 screened infants had developed ROP. Both eyes suffered from ROP in all the cases. The incidence of ROP was 16.67%. Of 19 cases(15.08%)developed ROP less than prethreshold and 2 cases(1.59%)developed threshold ROP. Among the 126 screened infants, 13(31.71%)out of 41 premature infants with birth weight(BW)<1500g and 8(9.41%)out of 85 with 1500g≤BW<2000g developed ROP, 15(30.61%)out of 49 with gestational age (GA)<32W and 6(7.79%)out of 77 with GA≥ 32W developed ROP. The incidence of ROP either among the groups of BW<1500g andl500g≤BW<2000g(x2=9.899, P <0.01), or among the groups of GA<32W and GA≥32W(x2=11.227, P<0.01)had statistical differences. Conclusions The incidence of ROP is 16.67% in Dongguan People's Hospital in present study. The incidence of severe ROP is low. Birth weight and gestational age are important factors to affect ROP incidence.     

Results of treatment of retinal detachment in active stage-5 retinopathy of prematurity

PURPOSE: To evaluate the surgical and functional results of encircling scleral buckling in treatment of active stage 5 retinopathy of prematurity. MATERIAL AND METHODS: 68 premature infants (121 eyes) with active stage 5 ROP operated with the use of the modified encircling buckling technique. The surgical and functional results were compared with the results observed in 91 unoperated children with active stage 5 ROP. RESULTS: In the operated group total retinal reattachment was observed in 52% and partial reattachment in 24.5% of premature infants. The surgery failed to reattach the retina in 23.5%. Visual acuity was: no light perception in 56.1%, light perception to 0.02 in 24.5% and 0.02 to 0.2 in 19.4% of children. In unoperated group spontaneous reattachment was observed in 6% of infants and visual acuity was: no light perception in 76%, light perception in 20% and finger counting in 4% of them. CONCLUSION: The obtained results indicate, that modified encircling buckling can be an effective treatment in reattaching the retina in stage 5 ROP although useful vision can be obtained in only 20% of operated children.