April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Outcome Of Laser Treatment Of AP-ROP In ELBW Babies
Author Affiliations & Notes
  • Glen A. Gole
    Ophthalmology, Royal Childrens Hospital, Brisbane, Australia
    Paediatrics and Child Health, University of Queensland, Brisbane, Australia
  • David J. Gunn
    Ophthalmology, Royal Childrens Hospital, Brisbane, Australia
  • David Cartwright
    Neonatology, Royal Brisbane and Women's Hospital, Brisbane, Australia
  • Footnotes
    Commercial Relationships  Glen A. Gole, None; David J. Gunn, None; David Cartwright, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 3147. doi:
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      Glen A. Gole, David J. Gunn, David Cartwright; Outcome Of Laser Treatment Of AP-ROP In ELBW Babies. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3147.

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Abstract

Purpose: : To describe outcomes of diode laser panretinal photocoagulation for aggressive posterior ROP (AP-ROP) in ELBW infants between 23 and 25 weeks 6 days (25.6 weeks) gestational age (GA)

Methods: : 554 infants between 23 and 25.6 weeks GA were admitted to the RBWH NICU between 1992 and 2009. 373 (67.3%) survived until screening (746 eyes).304 (81.5%) patients were diagnosed with ROP and 128 eyes in 66 infants required laser therapy.There were 38 males and 28 females in the treatment group including five sets of twins.

Results: : The mean post-menstrual age (PMA) at initial examination was 32.0 ± 1.3 weeks (range 28.1-35.3 weeks). Prevalence of ‘Rush’ disease, later designated as aggressive posterior ROP (ICROP II) was 11.7% (15/128 treated eyes). The overall prevalence of AP-ROP in the entire screened cohort was 2.0% (15/746 eyes). Though mean GA was similar, birth weight of patients that developed AP-ROP was significantly less than those of patients with non AP-ROP. Treatment of AP-ROP eyes occurred at a mean PMA of 34.1 ± 1.6 weeks (range 33.0-37.0 weeks). AP-ROP eyes received 3011 ± 967 total laser spots on average with power ranging from 270-1400mW. This was significantly more than non AP-ROP eyes. Two AP-ROP patients died before leaving NICU. No deaths were attributed to screening examinations, anaesthetic or laser treatments. Regression occurred in 9 of 11 remaining AP-ROP eyes, but one eye advancing to Stage 4b and one eye to Stage 5. Vitrectomy was performed in two eyes. Zone 1 and AP-ROP disease at treatment were associated with worse structural outcomes than Zone 2 disease (82.6% and 86.7% vs. 97.1% regressed ROP respectively). Visual outcomes were poor in the AP-ROP patients - five eyes had 20/40 vision; one eye had 20/400; three eyes had NPL; one eye good fixation; and one eye poor fixation.

Conclusions: : Diode laser treatment has a very high safety profile and provides very good structural outcomes overall in ELBW infants. Although AP-ROP patients had worse structural outcomes than non AP-ROP after treatment, nearly 90% still achieved regression. Despite this, AP-ROP patients in general had substantially poorer visual outcomes at follow up. Of the 11 AP-ROP eyes, five had little to no vision at follow-up. Conventional laser treatment alone does not appear to offer overall good visual outcomes for AP-ROP; this subgroup of patients with proliferative ROP might well benefit from intraviteal bevacizumab (Avastin) either alone or as an adjunctive therapy in order to secure better visual outcomes.

Keywords: retinopathy of prematurity 
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