A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 1. Visual function and structural outcome

doi:10.1016/S0161-6420(01)01017-X

Ophthalmology

Volume 109, Issue 5, May 2002, Pages 928-934

Presented in part at the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 2001.

https://doi.org/10.1016/S0161-6420(01)01017-X Get rights and content

Abstract

Objective

To assess visual and structural outcomes after laser photocoagulation and transscleral cryotherapy for threshold retinopathy of prematurity (ROP) after 10 years.

Design

Extended follow-up of a randomized controlled clinical trial.

Participants

One hundred eighteen eyes from 66 patients were randomly assigned to receive either cryotherapy or laser photocoagulation for threshold ROP. Forty-four eyes from 25 patients were examined for 10-year follow-up evaluations.

Intervention

Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, slit-lamp, and fundus examination; fundus photography; and B-scans (eyes with retinal detachments) were performed. Patients’ histories were taken to elicit past amblyopia therapy. Based on fundus photographs, independent observers graded the degree of retinal dragging as none, mild, moderate, or severe.

Main and secondary outcome measures

Best-corrected ETDRS visual acuity (BCVA). The degree of dragging was determined clinically and photographically. In addition, the presence of strabismus or amblyopia and/or any history of treatment for amblyopia were noted accordingly.

Results

Eyes treated with laser had a mean BCVA of 20/66 (Snellen equivalent), whereas cryotherapy-treated eyes had a mean BCVA of 20/182 (Snellen equivalent) (P = 0.015, n = 42). Compared with eyes treated with cryotherapy, eyes treated with laser photocoagulation were 5.2 times more likely to have a 20/50 or better BCVA (95% confidence interval, 1.37–19.8, n = 42). Eyes treated with cryotherapy were 7.2 times (95% confidence interval, 1.54–33.6, n = 33) more likely to develop retinal dragging compared with laser treatment. By linear regression analysis, ETDRS visual acuity was inversely proportionate to the degree of retinal dragging in both laser (r = −0.637, P = 0.006) and cryotherapy (r = −0.517, P = 0.040) treated eyes. Among the 21 patients with favorable outcomes in both eyes, 13 had strabismus (62%) and 6 had received amblyopia therapy (29%). Ptosis, loss of cilia, and cortical cataract were among probable treatment-related complications that were noted in this study.

Conclusions

Overall, laser-treated eyes had better structural and functional outcome compared with eyes treated with cryotherapy.

Section snippets

Materials and methods

The clinical objective of this study was to evaluate the anatomic and visual results of these patients in the two treatment groups (cryotherapy and laser) 10 years after treatment. The relationship of visual acuity to anatomic outcome was also examined.

Results

The mean age at follow-up was 9.9 years (range, 8.6–11.1 years). Of the 25 patients, 11 (44%) were male and four (16%) were African American. This cohort of patients had an average gestational age of 26 weeks (range, 23–33 weeks). Their mean birth weight was 807 g (range, 440–1477 g).

Cryotherapy-treated and laser-treated eyes had similar preoperative characteristics. The mean number of clock hours of stage 3 disease and percentage of eyes with zone 1 disease for each of the treatment groups are

Discussion

After roughly a decade, many of the children who returned for follow-up evaluations were cognitively capable of cooperating with our study. Our results show that visual acuity is significantly better in those eyes treated with laser photocoagulation into late childhood. This significant difference persisted despite administration of amblyopia therapy (where appropriate) in these patients. The probability that chance alone accounted for the difference in visual acuity between the two treatment

Acknowledgements

The authors thank Andrew Smith, PhD, for his extensive statistical assistance with this article.

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^☆: Supported by an unrestricted grant from Research to Prevent Blindness, New York, New York, and by a grant from Iridex Corporation, Mountain View, California.

¹: None of the authors has any financial or proprietary interest in any of the techniques or equipment discussed in this article.

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Article for CME CreditA comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 1. Visual function and structural outcome1 ☆,

Abstract

Objective

Design

Participants

Intervention

Main and secondary outcome measures

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Ophthalmology

Am J Ophthalmol

Ophthalmology

J AAPOS

Multicenter trial of cryotherapy for retinopathy of prematurity. Preliminary results. Cryotherapy for Retinopathy of Prematurity Cooperative Group

Arch Ophthalmol

Diode laser photocoagulation for retinopathy of prematurity. Preliminary results

Arch Ophthalmol

Laser therapy for retinopathy of prematurity. Laser ROP Study Group

Arch Ophthalmol

Article for CME Credit
A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 1. Visual function and structural outcome¹ ☆,