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R. M. Banda, V. H. Gonzalez, A. Garcia, G. P. Giuliari, V. R. Vann, J. Y. Su, D. A. Guel; Long Term Assessment of Confluent Laser Photocoagulation for the Treatment of Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3115.
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Although most ophthalmologists agree that laser photocoagulation has a better treatment outcome when compared to cryotherapy, the number and density of laser spots remains controversialLaser treatment can be done in a scattered pattern (1.5 burn width between each laser spot); a near-confluent pattern (1 burn width apart); and a confluent treatment pattern. The purpose of this study is to assess the safety and efficacy of the confluent technique by evaluating the rate of progression, frequency of retreatment, complication rate, structural outcomes and post-treatment refractive error in a cohort of infants with ROP.
A retrospective review of patients that received treatment for ROP in one or both eyes from 2003 to 2006 from a clinical setting. Confluent laser treatment was applied anterior to the ridge extending to the ora serrata 3600, leaving no space between laser spots. Supplemental laser was applied if needed. The rate of progression to stage 4 or 5, the frequency of additional treatment, postoperative complications were evaluated, as well as structural outcomes and refractive error at final visit.
A total of 129 eyes from 65 patients were included in this study. The mean gestational age was 27 wks (range, 22-32 wks) and the mean birth weight was 1002g. (range, 477 -1939g). Patients had a mean follow-up of 22 months (range, 2-43 months).Progression to stage 4 or 5 occurred in a total of 6 eyes (4.6%); of this group, 5 eyes (3.8%) had zone 1 or posterior zone 2 disease and 1 eye had anterior zone 2 (0.7%).In two patients, 3 eyes (2.3%) required additional laser treatment due to persistence of the disease; all 3 had zone 1 or posterior zone 2.Post operative complications included cataract (<1%), vitreous hemorrhage (<1%) and corneal edema (<1%); macular dragging was found in 5 eyes (3.8%).Mean spherical equivalent at the last follow-up was -3.1D (range, -19 to +4)
In the cohort of patients with ROP treated with confluent laser photocoagulation a lower rate of progression to a stage 4 or 5 ROP was noted. Furthermore, there was less need for additional laser treatment, with rates of complications and structural outcomes similar to previous reports using non-confluent laser pattern. It should be noted that in this study we found a mean spherical equivalent slightly higher than previous reports.It may therefore be concluded that confluent laser treatment is safe, efficient and efficacious in the treatment of ROP.
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