Elsevier

Ophthalmology

Volume 100, Issue 2, February 1993, Pages 238-244
Ophthalmology

Diode Laser Photocoagulation for Threshold Retinopathy of Prematurity: A Randomized Study

https://doi.org/10.1016/S0161-6420(93)31664-7Get rights and content
Under a Creative Commons license
open archive

Background: Although peripheral cryotherapy decreases the incidence of unfavorable anatomic outcomes in threshold retinopathy of prematurity (ROP), apnea, bradycardia, and lid edema can occur. Argon laser indirect ophthalmoscope photocoagulation has been used as an alternative to cryotherapy, with fewer adverse effects. Retinal lesions placed with diode lasers are deeper than similar argon laser lesions, and it is not known whether this difference could influence the response to ablative therapy.

Methods: Patients were enrolled under a prospective, randomized protocol. One eye of each patient with symmetric, threshold ROP was treated with an 814/815 nm diode laser, while the other eye was treated with cryotherapy. Patients with asymmetric disease also were randomized for treatment in the threshold eye.

Results: Nineteen infants (33 eyes) were treated, ranging from 485 to 863 g birth weight (23 to 27 weeks gestational age); 18 patients (32 eyes) were followed for 3 months or longer. Four patients (8 eyes) had bilateral zone 1 disease. Postconceptional age was 36 to 45 weeks at the time of treatment. The diode laser treatment was better tolerated than cryotherapy, and the treatment apparatus was more easily transported. Apneic episodes requiring intubation resulted from two cryotherapy sessions but no diode laser sessions. Five cryotherapy-treated eyes required retreatment because of persistent disease with adjacent skip areas. In the group followed for 3 to 15 months, 1 cryotherapy-treated eye and 1 diode laser-treated eye progressed to stage 5 retinal detachment.

Conclusion: Compared with cryotherapy, the diode laser was more convenient, technically easier to administer, and better tolerated by the patient. Although the number of patients was too small for meaningful statistical analysis of outcome, diode laser peripheral retinal ablation appeared to be as effective as cryotherapy for the treatment of threshold ROP.

Cited by (0)

Presented in part at the Association for Research in Vision and Ophthalmology meeting, Sarasota, May 1992, and at the American Academy of Ophthalmology Annual Meeting, Dallas, November 1992.

Supported in part by the Heed Ophthalmic Foundation, Cleveland, Ohio, and the National Children's Eye Care Foundation, Dallas, Texas (Dr. Hunter).

The authors have no proprietary interest in the development or marketing of the Iris diode laser or any competing instrument.