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Robison V. Chan, Kai B. Kang, Anton Orlin, Michael F. Chiang, Thomas C. Lee; Digital Imaging Identification Of Skip Lesions In Laser Treatment Of Retinopathy Of Prematurity. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5876.
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To identify common locations of skip lesions in laser-treated retinopathy of prematurity (ROP) eyes and to evaluate the utility of wide-angle digital imaging in detecting and documenting skip lesions in laser photocoagulation treatment for ROP.
Retrospective review of digital retinal images (RetCam-II) of 22 eyes of 12 infants who had undergone laser treatment for ROP performed by ophthalmologists within the first two years of completing residency. Presence of skip lesions was determined by masked review of photographs. The location of skip lesions was classified based on two axes: 1) circumferential (in one of six clock-hour regions), and 2) radial (adjacent to intraretinal ridge, adjacent to ora serrata, or isolated patches of greater than 1 laser burn width). Data was analyzed using Pearson’s chi-square test.
A total of 30 skip lesions were identified. Based on circumferential location, a significant difference in lesion distribution was found (p=0.016). Regions with the highest percentage of skip lesions were between the clock-hours 11:00 to 1:00 (45%), and 5:00 to 7:00 (41%). Based on radial location, 40% of all lesions were found near the ora serrata, 17% near the ridge, and 43% as isolated patches (P=0.14).
Skip lesions after laser photocoagulation were often encountered by wide-angle digital imaging, after being missed during the initial treatment procedure. Discrepancy in the distribution of skip lesions may be attributed to technical difficulty in performing the procedure amongst other factors disturbing visualization such as corneal clouding or hyphema occurring during laser. Most skip lesions in this study occurred in the superior or inferior retina. Digital imaging can assist in visualizing all regions of the retina, can identify missed areas of laser treatment, and may reduce the need for re-treatment after initial laser for ROP.
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