Anterior segment complications after diode laser photocoagulation for prethreshold retinopathy of prematurity

To evaluate anterior segment complication rates in eyes treated for prethreshold versus threshold retinopathy of prematurity (ROP) and look for potential risk factors.

Retrospective, observational case series study.

All patients treated with diode laser for ROP between 1995 and 2007 were identified. A total of 259 eyes of 184 patients were studied, 120 eyes in the pretheshold group and 139 eyes in the threshold group. We compare baseline characteristics, treatment parameters, ocular complications, and structural outcomes after treatment. The main outcome measured was anterior segment complication rates in eyes treated for prethreshold versus threshold ROP and we looked for potential risk factors.

Thirteen of 120 eyes treated at prethreshold had anterior segment complications versus 0 of 139 treated at threshold (P < .01). All eyes developed post-laser hyphema, 3 with elevated intraocular pressure. Three eyes developed cataract (2 requiring cataract extraction); 1 required treatment for band keratopathy. The mean postmenstrual age at treatment was significantly different between the prethreshold and threshold groups (36.6 vs 37.9 weeks, P = .03); eyes with anterior segment complications were treated at mean postmenstrual age of 35.7 weeks. No difference was found based on gestationtal age at birth, birth weight, zone, stage, or number of laser spots for eyes with anterior segment complications. Most anterior segment complications (77%) resolved without long-term sequelae.

Younger postmenstrual age at laser treatment may be related to an increased risk of anterior segment complications, which should be recognized and managed appropriately.