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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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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)
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.
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.
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.
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