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A. Ingram, K. Tawansy, A. Ells, P. Shah; Aggressive Diagnosis and Management of Aggressive Posterior Retinopathy of Prematurity (ROP) . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5317.
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© ARVO (1962-2015); The Authors (2016-present)
Aggressive posterior ROP (AP–ROP), a term in the revised International Classification of ROP, defines the most severe form of ROP, which if not identified in a timely fashion, will progress rapidly to stage 5. An increasing incidence of AP–ROP in the last 5 years has lead treating ophthalmologists to resort to modified, more aggressive laser treatment. AP–ROP characteristics include posterior location, plus disease in all 4 quadrants, flat neovascularization and aggressive tempo of disease progression.
This is a retrospective, non–comparative multicenter, series of infants with AP–ROP from 2000–2005. Wide field photographic imaging with or without retinal fluoresceine angiography, was used to define the leading edge of intrinsic vascular development and potential unrecognized skip area post–initial laser treatment. Newer, aggressive retinal ablative techniques were employed in the management of these infants.
120 infants from 3 tertiary centers, in 3 countries were routinely screened according to the respective guidelines. Mean gestational age was 27wks (range 23–37wks) and mean birthweight was 890g (range 470 – 2200g). Initial and secondary ablative laser photocoagulation using indirect diode laser of the avascular and vascular retina was performed using modified, aggressive laser techniques listed in Table 1. Post–menstrual age and mean chronological age at time of treatment was 38 weeks and 12 weeks respectively. Primary outcome was resolution of plus disease and elimination of neovascularization, which occurred in 75 % of infants with preservation of normal macular architecture. Secondary outcome was prevention of retinal detachment requiring surgery, which occurred in 82%. Digital photographic documentation of each technique will be presented. Table I: Aggressive Laser Techniques Employed 1. Confluent laser burns
2. Aggressive laser technique of direct laser of shunt
3. Laser posterior to the ridge–EFP complex
4. Laser of the notch
5. Laser into the posterior non–perfused loops
6. PRP–like laser pattern
There is an international risk for AP–ROP, despite demographic differences in these babies. Our data suggests acute surveillance, with early recognition of signs of AP–ROP, combined with aggressive laser techniques, will result in improved visual outcomes.
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