Confluent Laser Photocoagulation for the Treatment of Retinopathy of Prematurity

Abstract

Educational Objectives 1. To review the current treatments for retinopathy of prematurity (ROP) following CRYO-ROP and ETROP guidelines. 2. To review the use of laser photocoagulation in the treatment of ROP. 3. To describe the rate of progression, frequency of retreatment, complication rate, structural outcomes, and post-treatment refractive error following laser photocoagulation treatment of ROP. Purpose: To describe the efficacy, outcomes, and complications of confluent laser technique in a cohort of premature infants with threshold retinopathy of prematurity. Laser photocoagulation has a good treatment outcome in the management of retinopathy of prematurity; however, the number and density of laser spots remains debatable. Laser treatment can be done in a scattered pattern, a near-confluent pattern, or a confluent treatment pattern. Methods: A retrospective chart review of patients with threshold retinopathy of prematurity treated between 2003 and 2006 was conducted. Confluent laser treatment was applied anterior to the ridge extending to the ora serrata 360˚. Rate of progression, frequency of retreatment, postoperative complications, structural outcomes, and refractive error were evaluated. Results: A total of 100 eyes from 51 patients were included. Mean gestational age was 28 weeks (range: 23 to 32 weeks) and mean birth weight was 1,065 g (range: 477 to 1,905 g). Patients had a mean follow-up of 13 months (range: 6 to 50 months). Progression to stage 4 or 5 occurred only in a total of 6 eyes (6%). Postoperative complications included cataract, vitreous hemorrhage, corneal edema, and macular dragging. Mean spherical equivalent at the last follow-up visit was −3.80 diopters (range: −19.00 to + 4.00 diopters). Conclusion: Patients treated with confluent laser photocoagulation had a low rate of progression to stage 4 or 5 retinopathy of prematurity. Also, the need for additional laser treatment was small, with rates of complications and structural outcomes comparable to previous reports using a nonconfluent laser pattern. [J Pediatr Ophthalmol Strabismus 2010;47:81–85.]