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Parag Shah, Amrutha Sindhu, Venkatapathy Narendran; Structural outcome of posterior to ridge laser treatment for severe stage 3 retinopathy of prematurity. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):981.
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Posterior to ridge laser treatment for stage 3 retinopathy of prematurity (ROP) is controversial. We performed a retrospective, case-control study to test if structural outcomes of additional posterior to the ridge diode laser photocoagulation are better than conventional laser to anterior avascular retina only, in cases with stage 3 ROP.
A retrospective chart review was done for 42 eyes of 24 babies who underwent diode laser photocoagulation for severe stage 3 ROP from May 2013 to December 2013. Informed consent was taken from all the parents. 21 eyes were given laser only to the anterior avascular retina (control group) while remaining 21 were given additional extra two rows of laser posterior to the ridge in the vascularized retina (study group). The two groups were compared and analyzed at six months of follow up. All lasers were done under topical anesthesia. RetCam images were taken for documentation at 2 weeks, 1, 3 and 6 months follow up.
Eighteen babies had bilateral symmetrical stage 3 ROP while six babies had unilateral disease. The mean gestational age and birth weight was 29.8 ± 1.89 weeks and 1310 ± 400 grams in the study group and 30 ± 2.12 weeks and 1341 ± 396 grams in the control group. In both the groups sixteen eyes (76.2%) had zone 2 while five (23.8%) had zone 1 disease. Immediate post laser vitreous hemorrhage was seen in two eyes (9.5%) in study group and one eye (4.8%) in control group which was not statistically significant (p > 0.05). The vitreous hemorrhage was mild and none required any surgical intervention. Four eyes (19%) in study group and five (23.8%) in control group required additional laser for persistent active disease at 2 week follow up which again was not significant statistically (p > 0.05). At 6 months follow up, both the groups showed equal and complete regression in 20/21 eyes (95.2%). One eye from each group progressed to stage 4A which required vitrectomy.
Posterior to ridge laser treatment for severe stage 3 ROP did not show any additional benefit compared to conventional laser. We recommend a randomized controlled trial with larger sample size to substantiate this.
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