Visual outcomes after laser photocoagulation for threshold retinopathy of prematurity

doi:10.1016/S0161-6420(99)90343-3

Ophthalmology

Volume 106, Issue 9, 1 September 1999, Pages 1734-1738

Presented in part at the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 1998.

https://doi.org/10.1016/S0161-6420(99)90343-3 Get rights and content

Abstract

Objective

To determine the long-term visual acuity after diode laser photocoagulation for threshold retinopathy of prematurity.

Design

Retrospective, noncomparative case series.

Intervention

Photocoagulation of the peripheral avascular retina with a diode laser indirect ophthalmoscope.

Main outcome measures

The principal outcome evaluated was best-corrected visual acuity (BCVA). The most recent refractions for these eyes were also collected for analysis.

Participants

Thirty-five infants with threshold retinopathy of prematurity treated with laser photocoagulation from 1991 to 1996.

Results

After bilateral laser treatment, 14 (56%) of 25 patients who were capable of accurate visual acuity testing had 20/50 or better BCVA in at least 1 eye with 11 (44%) of 25 patients having at least 20/50 BCVA in both eyes. After unilateral treatment, four (40%) of ten had 20/50 or better BCVA in the treated eye while five (50%) of ten laser-treated eyes had a BCVA at least equal to the untreated fellow eye. Compared to eyes with 4 or more diopters (D) of myopia, those with less than 4 D of myopia were 6.4 times more likely to achieve 20/50 or better BCVA (95% confidence interval, 1.7–22.7). The average age at follow-up was 3.7 years.

Conclusions

After laser photocoagulation for threshold retinopathy of prematurity, 29 (48%) of 60 eyes had 20/50 or better visual acuity. Eyes with 4 or more D of myopia were significantly less likely to achieve 20/50 or better visual acuity than eyes with less than 4 D of myopia.

Section snippets

Materials and methods

The records of a Wills Eye Hospital-based vitreoretinal practice were searched to identify all patients treated with laser for threshold ROP from 1991 to 1996. In this noncomparative case series, threshold ROP was defined as five or more contiguous or eight or more cumulative clock-hours of stage-3 ROP in the presence of “plus” disease.1 Once threshold ROP was noted, laser photocoagulation was performed as described elsewhere.9

In June 1997, data forms were mailed to the last pediatric

Results

The patients identified in this series averaged 3.7 years of age (standard deviation [SD], 1.3 years) at follow-up. The mean gestational age of the infants in this series was 25.3 weeks (SD, 1.6 weeks), and their mean birthweight was 777 g (SD, 166 g). On average, 7.7 clock-hours (SD, 2.7 clock-hours) of stage-3+ disease were present before treatment. Fourteen (16%) of 90 eyes treated had threshold disease in zone 1, whereas the remaining 76 eyes (84%) had zone-2 disease. Table 1 contains a

Discussion

With greater success in the prevention of unfavorable outcomes from ROP, our goal, as stated earlier, should be to optimize visual outcome. Some of the major causes of poor visual acuity in this series were anatomic problems such as retinal detachment and macular heterotopia. Nonetheless, many eyes that were anatomically normal had poor visual outcomes. On average, the laser-treated eyes had an SE of 4.8 D of myopia. Reported mean SEs after laser photocoagulation range from −0.5 to −6.5 D.7, 8,

References (14)

J.A. McNamara et al.
Laser photocoagulation for stage 3+ retinopathy of prematurity
Ophthalmology
(1991)
B.P. Connolly et al.
A comparison of laser photocoagulation with trans-scleral cryotherapy in the treatment of threshold retinopathy of prematurity
Ophthalmology
(1998)
G.E. Quinn et al.
Development of myopia in infants with birth weights less than 1251 grams
Ophthalmology
(1992)
G.E. Quinn et al.
Prevalence of myopia between 3 months and 5 $12$ years in preterm infants with and without retinopathy of prematurity
Ophthalmology
(1998)
Multicenter trial of cryotherapy for retinopathy of prematurity. Three-month outcome
Arch Ophthalmol
(1990)
D.A. Iverson et al.
Laser photocoagulation for threshold retinopathy of prematurity
Arch Ophthalmol
(1991)
M.B. Landers et al.
Treatment of retinopathy of prematurity with argon laser photocoagulation
Arch Ophthalmol
(1992)

There are more references available in the full text version of this article.

Cited by (21)

Influence of naloxone and methysergide on the analgesic effects of low-level laser in an experimental pain model
2010, Revista Brasileira de Anestesiologia
Although the mechanism of action of laser phototherapy (LPT) is not known, it is a promising analgesic method. The aim of this study was to evaluate whether the action of LPT depends on the activation of peripheral opioid or serotonergic receptors.
Inflammatory pain was induced through the injection of carrageenin in the left posterior paw of male Wistar rats. The InGaAIP visible laser diode (660 nm) with fluency of 2.5 J.cm^-2 was used. Von Frey filaments were used to analyze mechanical hyperalgesia. Animals were separated into five groups: Carrageenin; Laser (LPT); Non-coherent light; LPT + Naloxone; and LPT + Methysergide.
Low-Level Laser phototherapy proved to be an effective analgesic method, while non-coherent light did not show a similar effect. The use of naloxone blocked the analgesic effect of LPT, while methysergide did not affect LPT-induced analgesia.
According to the parameter used in this study, LPT produced analgesia. Analgesia induced by laser phototherapy is mediated by peripheral opioid receptors. Laser phototherapy does not seem to interact with peripheral serotonergic receptors.
A fototerapia com laser (LPT) é um método analgésico promissor, embora seu mecanismo de ação não seja totalmente conhecido. O objetivo deste estudo foi avaliar se a ação da LPT é dependente da ativação de receptores opioides ou serotoninérgicos periféricos.
Foram utilizados ratos Wistar machos. A dor produzida foi de caráter inflamatório, através da injeção de carragenina na pata posterior esquerda dos ratos. O laser utilizado foi o Photon Lase III em meio ativo InGaAIP (660 nm), fluência de 2,5 J.cm^-2. Analisou-se a hiperalgesia mecânica utilizando filamentos de von Frey. Os animais foram separados em cinco grupos: Carragenina; Laser (LPT); Luz não coerente; LPT + Naloxona e LPT + Metisergida.
A fototerapia com laser em baixa intensidade mostrou-se um método analgésico eficaz, enquanto o emprego de fonte de luz não coerente não mostrou ter efeito analgésico. O uso de naloxona bloqueou o efeito analgésico do LPT; já o uso de metisergida não afetou a analgesia do LPT.
A LPT nos parâmetros utilizados apresentou efeito analgésico. A analgesia da LPT é mediada por receptores opioides periféricos. A LPT parece não interagir com receptores serotoninérgicos periféricos.
La fototerapia con láser (LPT) es un método analgésico promisorio, aunque su mecanismo de acción no se conozca en su totalidad. El objetivo de este estudio fue evaluar si la acción de la LPT es dependiente de la activación de receptores opioides o serotoninérgicos periféricos.
Se usaron ratones Wistar machos. El dolor generado fue de carácter inflamatorio, a través de la inyección de carragenina en la pata posterior izquierda de los ratones. El láser utilizado fue el GaIAsAl (660 nm), fluencia de 2,5 J.cm^-2. Se analizó la hiperalgesia mecánica utilizando filamentos de von Frey. Los animales se dividieron en cinco grupos: Carragenina; Láser (LPT); Luz no coherente; LPT + Naloxona y LPT + Metisergida.
La fototerapia con láser en baja intensidad demostró ser un método analgésico eficaz, mientras que el uso de la fuente de luz no coherente no demostró poseer ningún efecto analgésico. El uso de naloxona bloqueó el efecto analgésico del LPT, mientras que el uso de metisergida no afectó la analgesia del LPT.
La LPT en los parámetros utilizados tuvo un efecto analgésico. La analgesia de la LPT es mediada por receptores opióides periféricos. La LPT parece que no interactúa con los receptores serotoninérgicos periféricos.
Combined use of cryotherapy and diode laser photocoagulation for the treatment of threshold retinopathy of prematurity
2003, Journal of AAPOS
Cryotherapy and indirect laser retinal photoablation are both effective in the treatment of retinopathy of prematurity (ROP). We describe the safety, efficiency, and effectiveness of combined cryotherapy and diode laser photocoagulation to treat threshold ROP.
Records of patients developing threshold ROP from January 1, 1996 through December 31, 1998, were retrospectively reviewed to identify those treated with combined cryotherapy and photocoagulation and followed up for at least 45 days postoperatively. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Data reviewed included ocular and systemic complication rates, treatment duration, number of laser burns, most recent fundus examination, visual acuity, and refraction.
In 13 patients, 23 eyes received combined treatment. No intraoperative complications occurred. Mean duration of anesthesia and treatment was 35 ± 8 minutes/eye. A mean of 117 ± 84 laser burns/eye were applied. In 20 of 23 eyes (87.0%), anatomic outcome was favorable at last examination. In 13 of 16 eyes (81.3%), functional (visual acuity) outcome was favorable (visual acuity better than 20/200) at 1 year. At 6 months or later, 14 of 16 eyes (87.5%) measured were myopic, of which 5 (31.3%) were highly myopic (> 6 diopters).
The effectiveness of treating ROP with combined cryotherapy and diode laser photocoagulation compares with that of either modality alone. By decreasing the number of laser applications, combined therapy may be faster and technically easier for eyes with very posterior ROP. This may decrease the number of complications seen when either excessive cryotherapy or laser retinal photoablation is used.
Clinical outcome of confluent laser photoablation for retinopathy of prematurity
2002, Journal of AAPOS
Purpose: During the past decade, laser photoablation has supplanted cryotherapy as the standard treatment for threshold retinopathy of prematurity (ROP). We evaluated the progression and the complication rate in a cohort of infants with threshold ROP treated with a confluent technique. Methods: We retrospectively studied 47 patients with ROP (91 eyes), treated with confluent diode laser photoablation. Four main outcomes were evaluated: (1) the rate of progression, (2) the frequency of laser retreatment, (3) postoperative complications, and (4) postoperative refractive error. Results: A mean of 1943 ± 912 laser burns were administered in a confluent pattern to 91 eyes with threshold ROP. Progression to stage 4 or 5 disease occurred in 13 of 29 eyes (44.8%) with zone I and posterior zone II and in 2 of 51 eyes (3.9%) with anterior zone II ROP (P = .01). Eyes with anterior zone II ROP that received more than or equal to 2000 burns progressed more than those that received fewer than 2000 burns. Only 1 eye (1%) needed a supplemental laser treatment. Postoperative complications included corneal edema (2.3%), anterior segment ischemia (2.3%), vitreous hemorrhage (7.9%), posterior synechiae (2.3%), cataract (4.9%), and macular ectopia (12%).The mean spherical equivalent at the last follow-up was −4.52 ± 5.63 D. Conclusions: In our series, infants received more laser burns than infants reported in the literature receiving scatter or near-confluent treatment. While confluent treatment almost eliminated supplemental treatment, it was associated with a similar rate of progression and complications as has been reported with other patterns of laser treatment. (J AAPOS 2002;6:81-5)
Retinopathy of prematurity: Clinical aspects
2001, Seminars in Neonatology
There have been many major advances recently that have improved the identification and management of retinopathy of prematurity (ROP). This chapter describes the clinical features of ROP and then considers briefly the incidence and epidemiology of acute phase disease. This is followed by a discussion of the two ROP epidemics and ROP-induced disability in high, low and middle income countries, and how this has been impacted by treatment. The principles and specifics of screening for ROP are considered, focusing on certain topical issues such as whether one screening guideline suits all populations. Treatment has undergone several advances, so that now laser therapy has overtaken cryotherapy as the preferred mode of treatment, and treatment at an earlier stage is now being considered. Finally, the authors attempt to look into the future and wonder how the criteria for treatment will change, and whether innovations in ocular imaging will impact ROP screening in both high and middle income countries.
Retinopathy of prematurity
2001, Ophthalmology Clinics of North America
Citation Excerpt :
Treatment is recommended for eyes at this threshold and consists of retinal ablation of peripheral avascular retina. Laser treatment has replaced cryo therapy at most centers.7 Many surgeons prefer diode laser, because it theoretically reduces the risk of cataract when aimed through a tunica vasculosa lentis.
Clinical observations of vitreoretinal surgery for four different phenotypes of X-linked congenital retinoschisis
2018, International Journal of Ophthalmology

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^☆: Supported by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York.

¹: None of the authors has any proprietary interests in the contents of this article.

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Visual outcomes after laser photocoagulation for threshold retinopathy of prematurity1☆,

Abstract

Objective

Design

Intervention

Main outcome measures

Participants

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Multicenter trial of cryotherapy for retinopathy of prematurity. Three-month outcome

Arch Ophthalmol

Laser photocoagulation for threshold retinopathy of prematurity

Arch Ophthalmol

Treatment of retinopathy of prematurity with argon laser photocoagulation

Arch Ophthalmol

Visual outcomes after laser photocoagulation for threshold retinopathy of prematurity¹☆,