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.     

Diode laser treatment of pre-threshold and threshold retinopathy of prematurity

Purpose: Retinopathy of prematurity (ROP) is a sight‐threatening condition of premature infants. This study aimed to investigate the efficacy of diode laser photocoagulation in the treatment of pre‐threshold and threshold ROP. Methods: A retrospective review was conducted of patients who underwent diode laser treatment for ROP by one author (GAG) from 1992 to 2000. During this time, 2137 babies <1500 g birthweight or <32 weeks post‐conception age were examined. Results: Seventy‐six eyes in 40 infants (20 male, 20 female) were treated for ROP. Treatment was performed on average at 37 weeks post‐conception age (range 31?50 weeks, SD = 3.2). The number of burns per eye for the first session of laser ranged between 193 and 1937 (mean 933), with power ranging from 200 to 1000 mW (mean 484). Eighteen (45.0%) of these 40 infants underwent a second session of laser (mean number of burns 683, range 167?1618), which was performed in 29 (38.2%) of the 76 eyes that initially underwent laser treatment. Complete regression was observed in 61 eyes (80.3%), occurring on average at 39 weeks post‐conception age (range 35?45, SD = 2.2). Six (7.9%) eyes progressed to stage IVA disease, two (2.6%) to stage IVB and three (3.9%) to stage V ROP. In the latter part of the study as the number of laser burns per eye increased it was found that the number of patients requiring a second session of laser treatment decreased, with no adverse outcomes observed in the last 3 years of the study. At last follow up, the average refractive error in the treated eyes was ?0.40 D spherical equivalent (range ?12.75 D to +4.25 D, SD = 3.0). The degree of myopia induced showed no significant correlation with the number of laser burns administered. Conclusion: Diode laser treatment is able to stop progression of ROP in the majority of cases.     

Diode laser treatment of retinopathy of prematurity: anatomical and refractive outcomes

PURPOSE: To examine the anatomical and refractive outcomes of infrared diode laser photocoagulation (DLPC) for the treatment of threshold retinopathy of prematurity (ROP). METHODS: The charts of all consecutive premature neonates with ROP treated by DLPC at our tertiary center from December 1, 1996, to December 31, 2004, were reviewed. RESULTS: The group included 100 neonates (194 eyes) with a mean birth weight +/- SD of 833.9 +/- 250.3 g and a mean gestational age +/- SD of 26 +/- 1.9 weeks. Sixty-two percent of neonates had zone I or posterior zone II ROP. Each eye received a mean +/- SD of 1,740 +/- 990 laser applications, and 21% of eyes received an additional 1 to 2 rows posterior to the ridge. Neonates treated after December 2003 (cutoff date of the Early Treatment of Retinopathy of Prematurity study) underwent a significantly greater number of laser applications (mean +/- SD, 2,286 +/- 1,087) than did neonates treated earlier. Anatomical results of laser treatment were favorable for 179 eyes (92.3%) at a mean follow-up +/- SD of 33.6 +/- 27.2 months. After vitreoretinal surgery, partial or total retinal detachment was documented for 2.5% of patients who received posterior-to-the-ridge laser treatment and 3.8% of patients treated only on the avascular retina. Refractive data were available for 134 eyes: 55.2% had myopia of -5 diopters (31.3%) or greater (23.9%). Strabismus was found in 21 (28.8%) of 73 neonates tested. Gestational age was correlated with corrected age at treatment, zone of ROP, number of laser applications, and spherical equivalent. Snellen visual acuity of 6/12 or more occurred in 17 of 24 patients who complied with testing. CONCLUSION: DLPC is a safe and effective treatment for ROP. Neonates of lower gestational age and birth weight require earlier and more aggressive laser treatment and may have a higher refractive error.     

Trans-scleral diode laser coagulation for therapy of acute retinopathia praematurorum

BACKGROUND: Lens opacities were noted in single cases after transpupillar laser photocoagulation in retinopathy of prematurity (ROP) using the laser indirect ophthalmoscope. The diode laser with its wavelength in the near infrared (810 nm) makes lens sparing transscleral retinal coagulation possible. PATIENTS AND METHODS: In a controlled clinical study 60 eyes of 30 very low birth weight infants (gestational age 23-31 weeks, mean 26.6 +/- 1.8 weeks; birth weight 510-1200 g, 856 +/- 170 g) with threshold ROP were treated with diode laser photocoagulation. One eye of each infant was coagulated transsclerally while the fellow eye had transpapillary coagulation using the laser indirect ophthalmoscope. Follow-up ranged from 2 to 38 months (19 +/- 11 months). RESULTS: In 29 (97%) out of 30 eyes treated transsclerally and in 30 (100%) out of 30 eyes treated transpapillary the outcome was a flat, attached retina. Three eyes had a second laser treatment and 2 eyes had additional retinal detachment surgery. One eye (3%) with zone I disease failed after transscleral laser treatment and additional retinal detachment surgery with partially detached retina (stage 4 B) No adverse side effects as a result of laser treatment were noted except for a small amount of retinal/preretinal bleeding in the ridge and a vitreous bleeding. There were no adverse side effects (e.g., bleeding, cataract formation) in the anterior segments of the eyes. CONCLUSION: Transscleral diode laser coagulation for treatment of threshold ROP proved to be as effective as transpapillary diode laser photocoagulation. Only minor side effects were noticed. Transscleral diode laser photocoagulation is an advantageous treatment method in eyes with preexisting risk of cataract formation in transpapillary laser treatment.     

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.     

影响1区早产儿视网膜病变激光治疗结果的因素分析

目的　观察影响1区早产儿视网膜病变（ROP）激光治疗效果的相关因素。方法　回顾性分析35例1区ROP患儿 69只眼的临床资料。所有患儿均经过间接检眼镜检查确诊,根据病变在视网膜的位置分为前部1区和后部1区,分别为49、20只眼。69只眼中急进性ROP（AP-ROP）12只眼,前部1区4只眼,后部1区8只眼。在+20 D透镜辅助以及巩膜压迫器压迫下,采用二极管间接检眼镜激光对嵴前周边视网膜无血管区进行激光光凝,随访观察时间2～48个月,平均观察时间（10.85±11.35）个月。嵴消退,病情稳定为治愈;视网膜病变进展为4期或5期为视网膜病变进展。结果　69只眼中,治愈42只眼,占60.87%;视网膜病变进展27只眼,占39.13%。前部1区49只眼中,治愈34只眼,占69.38%;进展15只眼,占30.62%。后部1区20只眼中,治愈8只眼,占40.00%;进展12只眼,占60.00%。前部1区和后部1区视网膜病变进展率比较,差异有统计学意义（χ2=5.15,P＜0.05)。AP-ROP 12只眼中激光光凝后视网膜脱离9只眼。发现视网膜病变进展的时间在激光光凝治疗后2～18周。Logistic回归分析表明,激光光凝治疗后ROP的进展与治疗前视网膜纤维血管网的范围有关（回归系数0.235,P=0.00）,与早产儿的出生体重（回归系数0.000,P=0.091）、胎龄（回归系数-0.037,P=0.359）、激光治疗时矫正胎龄（回归系数0.013,P=0.651）及激光光凝点数量（回归系数-5.7E-0.05,P=0.800）的多少无关。结论　1区ROP激光光凝治疗有效,前部1区的激光光凝治疗预后较后部1区好;激光光凝治疗后的视网膜病变进展与治疗前视网膜纤维血管网范围有关。     

Treatment of retinopathy of prematurity in extremely premature infants over an 18‐year period

Background: To report the efficacy of laser diode therapy in the treatment of retinopathy of prematurity (ROP) in extremely premature (EP) infants over an 18‐year period. Design: Retrospective study. Participants: One hundred twenty‐eight eyes in 66 infants treated between 23 and 25.6 weeks. Methods: Five hundred fifty‐four infants between 23 and 25.6 weeks gestational age (GA) were admitted to The Royal Brisbane and Women's Hospital Neonatal Intensive Care Unit (NICU) between 1992 and 2009. Three hundred seventy‐three patients survived to undergo screening, 304 were diagnosed with ROP, and 66 infants required diode laser therapy. Main Outcome Measures: Success of treatment, visual and refractive outcomes. Results: One hundred twenty‐eight eyes from 66 infants (18.8% of those screened) underwent laser treatment with a mean GA of 24.3 weeks and mean birth weight of 711.4g. Fifty‐six eyes were treated at pre‐threshold disease, and 72 eyes at threshold disease. Over the study period, the number of laser spots and regression rate of ROP increased, while the frequency of re‐treatment decreased. At 40 weeks, 119 eyes had regressed ROP (93%), two advanced to stage 4a, three to stage 4b and four to stage 5. Aggressive posterior ROP (AP‐ROP) occurred in 15 eyes (11.7% of those treated). Forty‐three patients (65%) were followed up for a mean of 56.5 months. The number of laser spots correlated well with subsequent refractive error but poorly with corrected visual acuity. Conclusions: In EP infants, laser diode therapy is an effective technique to halt the progression of ROP in most cases. AP‐ROP is uncommon, even in this subgroup of extremely premature infants.     

Diode laser photocoagulation to the vascular retina for progressively advancing retinopathy of prematurity.

AIMS--To estimate the effectiveness of diode laser photocoagulation of the retina posterior to the ridge in eyes with retinopathy of prematurity (ROP). METHODS--Diode laser photocoagulation was applied posterior to the fibrovascular ridge in stage 4a ROP in six eyes of four infants and in advancing stage 3+ in two eyes of one infant. Seven eyes had previously been unsuccessfully treated with diode laser photocoagulation anterior to the ridge. RESULTS--Six eyes of four children had total regression, two eyes of two children had flat maculae with residual peripheral tractional detachment and maintained vision. CONCLUSION--These preliminary results indicate that diode laser photocoagulation posterior to the ridge may be a useful treatment in late stage 3 and stage 4A ROP following failed laser treatment to the avascular retina in threshold stage 3 disease.     

Combined use of cryotherapy and diode laser photocoagulation for the treatment of threshold retinopathy of prematurity.

PURPOSE: Cryotherapy and indirect laser retinal photoablation are both effective in the treatment of retinopathy of prematurity (ROP). We describe the safety, efficiency, and effectiveness of combined cryotherapy and diode laser photocoagulation to treat threshold ROP. METHODS: Records of patients developing threshold ROP from January 1, 1996 through December 31, 1998, were retrospectively reviewed to identify those treated with combined cryotherapy and photocoagulation and followed up for at least 45 days postoperatively. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Data reviewed included ocular and systemic complication rates, treatment duration, number of laser burns, most recent fundus examination, visual acuity, and refraction. RESULTS: In 13 patients, 23 eyes received combined treatment. No intraoperative complications occurred. Mean duration of anesthesia and treatment was 35 +/- 8 minutes/eye. A mean of 117 +/- 84 laser burns/eye were applied. In 20 of 23 eyes (87.0%), anatomic outcome was favorable at last examination. In 13 of 16 eyes (81.3%), functional (visual acuity) outcome was favorable (visual acuity better than 20/200) at 1 year. At 6 months or later, 14 of 16 eyes (87.5%) measured were myopic, of which 5 (31.3%) were highly myopic (> 6 diopters). CONCLUSIONS: The effectiveness of treating ROP with combined cryotherapy and diode laser photocoagulation compares with that of either modality alone. By decreasing the number of laser applications, combined therapy may be faster and technically easier for eyes with very posterior ROP. This may decrease the number of complications seen when either excessive cryotherapy or laser retinal photoablation is used.     

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.     

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.     

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.     

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.     

【In Press】Effect of anti-VEGF treatment on retinopathy of prematurity in Zone II Stage 3+

AIM: To assess the effect of intravitreal ranibizumab injection for retinopathy of prematurity (ROP) in Zone II Stage 3+. METHODS: Data was collected from ROP patients with Zone II Stage 3+ who had intravitreal ranibizumab injections between October 2014 and January 2017 at the department of Ophthalmology in our hospital. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow-up visit. Gestational age at birth, birth weight, sex, ROP zone, ROP stage, post menstrual age (PMA) at treatment, and follow-up period were recorded. The final clinical status of the retina was noted for each patient. The primary outcome measures included ROP recurrences requiring re-treatment, complete or incomplete peripheral vascularization RESULTS: Eighty-six eyes of 46 premature infants with Zone II Stage 3+ROP were enrolled in the study. The mean gestational age at birth was 28.18±1.67wk (range: 25 to 33wk) and the mean birth weight was 1070.57±226.85 g (range: 720.00 to 1650.00 g). The mean PMA at treatment was 38.32±2.99wk (range: 32.29 to 46.00wk). Seventy-one eyes (82.56%) were treated successfully with intravitreal ranibizumab as monotherapy. Fifteen eyes (17.44%) developed recurrent disease. The mean interval between the treatment and retreatment was 5.96±3.22wk (range: 1.86 to 11.71wk). All eyes vascularized into zone III at the end of the study and among them 62 eyes (72.1%) achieved complete vascularization. CONCLUSION: Intravitreal ranibizumab injection is an effective treatment in patients with zone II stage 3+ ROP. More patients with longer follow-up duration are mandatory to confirm the safety and efficacy of this treatment.     

Prospective randomized evaluation of diode-laser and cryotherapy in prethreshold retinopathy of prematurity

PURPOSE: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP). METHODS: Thirty-six eyes of 18 premature infants less than 34 weeks gestational age and/or less than 1600 g birth weight with prethreshold ROP were prospectively randomized to treatment with either indirect laser photocoagulation or cryotherapy. Prethreshold ROP was defined as any stage of ROP in zone I with plus disease; or stage 3 with three or more contiguous clock hours or five or more total clock hours of involvement of retina in zone II with plus disease but less than threshold disease. Regression of the ROP was assessed for a minimum period of 6 months. RESULTS: Regression of ROP occurred in all 36 eyes (100%) in both groups. CONCLUSIONS: Excellent results are achieved if ROP is treated at the prethreshold stage with both indirect laser photocoagulation and cryotherapy. Although laser has definite advantages, cryotherapy can be considered as an alternative modality of treatment in developing countries due to economic reasons.     

Diode laser photocoagulation for retinopathy of prematurity: a histopathologic study

Laser photocoagulation has largely supplanted cryotherapy as an effective treatment for retinopathy of prematurity. This case describes the ocular histopathologic findings of a pair of eyes in a severely premature male infant treated with diode laser photocoagulation for bilateral stage 3 retinopathy of prematurity (ROP) for 360 degrees in zone 1 with severe plus disease. The right eye responded to treatment; the left eye developed persistent vitreous hemorrhage and total retinal detachment. The histopathologic examination of laser burns in the right eye disclosed segmental areas of chorioretinal scarring with retinal atrophy and gliosis, loss of RPE and extensive atrophy of the choroid and its vasculature, which involved both the choriocapillaris and larger vessels. The left eye had iris neovascularization, a chronic organized vitreous hemorrhage and a totally detached retina. The histopathologic findings in an eye of a premature infant with threshold ROP treated with diode laser photocoagulation resembled those reported after transsceral cryotherapy. Diode laser photocoagulation may produce less severe chorioretinal damage.     

Effect of two different doses of intravitreal bevacizumab with temporal retina-sparing laser photocoagulation for retinopathy of prematurity

This study aims to compare the efficacy and safety between two different doses of intravitreal bevacizumab (IVB) injection with temporal retina-sparing laser (TRSL) photocoagulation for retinopathy of prematurity (ROP). We retrospectively evaluated 22 eyes of ROP infants who underwent IVB combined with partial TRSL for stage 3+ zone I or posterior zone II ROP. Laser photocoagulation was applied on the avascular retina, sparing two-disc-diameter width temporal avascular area anterior to ridge. A half dose (0.625 mg) or minimal dose (0.25 mg) of IVB was conducted. Four eyes in minimal dose group were retreated with IVB and laser photocoagulation on the spared retina. Of those 4 retreated eyes, three developed preretinal hemorrhage around the ridge after the first treatment, resulting in fibrotic macular dragging. A half dose of IVB may be more effective than a minimal dose with partial TRSL for ROP. Preretinal hemorrhage may be a harbinger of poor prognosis.     

Diode laser photocoagulation for stage 3+ retinopathy of prematurity

Background: Laser photocoagulation in retinopathy of prematurity (ROP) appears to have fewer adverse effects than cryotherapy and seems to be at least as effective. Methods: To evaluate the efficacy and safety of diode laser photocoagulation, we included 42 eyes with stage 3+ ROP of 24 preterm infants (gestational age 24–29 weeks, mean ± SD 26.6 ± 1.3 weeks; birth weight 480–1400 g, 896 ± 196 g) in a prospective clinical study. Photocoagulation treatment was performed using a diode laser (810 nm) with a laser indirect ophthalmoscope delivery system. Follow-up ranged from 3 to 16 months (8.8 ± 4.0 months). Results: In 39 (93%) of 42 eyes ROP regressed after a single laser treatment and the outcome was a flat, attached retina. One eye (2%) had a second laser session and another eye (2%) had additional retinal detachment surgery, resulting in the regression of ROP and a flat, attached retina. Thus, the success rate was 41 (98%) out of 42 eyes. In one (2%) of the 42 eyes treatment failed and ROP progressed to stage 5, although additional retinal detachment surgery was performed. No adverse side effects of diode laser treatment were noticed except for a small amount of retinal/preretinal bleeding in the ridge in five eyes (12%) and a small postoperative anterior chamber hemorrhage in one eye (2%) with dense tunica vasculosa lentis. Neither lenticular opacities nor cataract formation were encountered. Conclusion: Diode laser photocoagulation for stage 3+ ROP showed only minor side effects and was at least as effective as cryotherapy treatment.     

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.