Major article
Clinical outcome of confluent laser photoablation for retinopathy of prematurity,☆☆

Presented at the 27th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Orlando, Florida, March 21-25, 2001.
https://doi.org/10.1067/mpa.2002.121452Get rights and content

Abstract

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. (J AAPOS 2002;6:81-5)

Section snippets

Materials and methods

A retrospective review was performed of the records of all patients with threshold ROP who underwent laser photoablation in 1 or both eyes by a retinal surgeon or a fellow affiliated with our institution between August 1997 and July 2000. We did not retrieve the records of patients treated prior to 1997 because a new database was installed at our institution in 1997 making it impossible to access the previously used database. Patients who underwent laser treatment by a surgeon not affiliated

Results

A total of 65 patients who underwent laser treatment for threshold ROP between August 1997 and July 2000 were identified. Records of 7 patients were not available. Three patients were excluded because they received a prior laser treatment by an outside surgeon. Of the remaining 55 patients, 8 (14.5%) had missing data and were excluded. A total of 91 eyes from 47 patients were included in the study. Twenty-four patients (51.1%) were male and 23 patients (48.9%) were female. The mean gestational

Discussion

Our study evaluated the outcome of eyes with threshold ROP treated with a confluent pattern of laser photoablation. The rationale behind the confluent treatment is to completely ablate the avascular retina to prevent the progression of the disease and to limit the need for supplemental treatment.

Ninety-one eyes of 47 patients were retrospectively studied. The mean number of laser burns applied per eye was 1943 ± 912 (range, 693-4535 spots); 29% of treated eyes received more than 2000 burns. The

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    Supported in part by a departmental grant from Research to Prevent Blindness, Inc, New York, New York, and a National Institutes of Health Core Grant (P30 EY06360).

    ☆☆

    Reprint requests: Scott R. Lambert, MD, Emory Eye Center, 1365-B Clifton Road, NE, Atlanta, GA 30322.

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