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Hemang K. Pandya, Lisa J. Faia, Kimberly A. Drenser; Macular Development in Advanced Posterior Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3148.
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Aggressive Posterior Retinopathy of Prematurity (AP-ROP) is a vitreoretinal abnormality affecting premature babies with extremely low birth weights. This study reports anatomic outcomes after early and complete laser photocoagulation of the entire avascular retina, including areas in close proximity to the fovea, in patients with AP-ROP. We propose novel mechanisms for macular development and ocular maturation and growth that contribute to our understanding of AP-ROP treatment.
Retrospective review of 6 eyes of 3 AP-ROP patients that underwent laser photocoagulation of the entire avascular retina. Serial photographic fundoscopic imaging was performed using RetCam® (MLI Inc., Pleasanton, CA) to compare retinal anatomy before and after treatment.
Mean birth weight and gestational age were 704.8g (range 525-829.3g) and 24.33 weeks (range 23.57-25.57 weeks), respectively. There were 2 female and 1 male patient. The average time to laser was 9.3 weeks after birth, with the mean postmenstrual age of 34 weeks (range 32-36 weeks). Two eyes had zone 1 and 4 eyes had posterior zone 2 disease. Four eyes required additional therapies due to persistent disease: 2 eyes required intravitreal bevacizumab (Avastin, Genentech, Inc., San Francisco, CA) followed by additional laser and 2 eyes required two separate treatments of pegaptanib (Macugen, OSI Pharmaceuticals, Inc., Long Island, NY). Three eyes went on to develop 4A detachments, which were successfully treated. Mean follow-up was 7 months (range 3-12 months). All 6 eyes experienced transverse growth, with expansion of the posterior pole and anterior displacement of the previous laser treatment.
Confluent photocoagulation of the entire avascular retina, regardless of foveal proximity, should be the mainstay for treating AP-ROP. Subsequent photocoagulation should be conducted within 10 days to areas previously hidden by neovascularization to ensure prudent therapy. Macular development may involve retinal stretching and/or AP retinal growth through yet to be established mechanisms
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