Intraocular Triamcinolone in the Management of Zone 1 Retinopathy of Prematurity Refractory to Laser Ablation of the Avascular Retina

Abstract

Abstract: : Purpose: To determine if intra-vitreal injection of a long-acting angiostatic steroid alters the incidence of tractional retinal detachment or neovascular activity that remains active after complete, near-confluent laser ablation in aggressive Zone 1 Retinopathy Of Prematurity (ROP). Methods: Interventional series of seven bilateral cases in which one eye was randomized to an intraocular injection of 2 mg of triamcinolone acetonide while the fellow eye received standard management. Fundus photographs, fluorescein angiograms, electroretinograms, and ultrasound images were reviewed for all cases. Post-mortem histology was performed in one case. Results: Eyes receiving steroid displayed more rapid reduction of plus disease and cicatrisation of new vessels. All eyes progressed to tractional retinal detachment regardless of treatment mode. Eyes injected with steroid were able to receive earlier lens-sparing vitrectomy with less post-operative hemorrhage and less post-operative re-proliferation. Conclusions: Although triamcinolone does not reduce the incidence of tractional retinal detachment in aggressive ROP, it may favorably alter neovascular activity and allow for earlier and safer vitreous surgery.

Keywords: retinopathy of prematurity • vitreoretinal surgery • drug toxicity/drug effects