Role of LASERS in stage 4A retinopathy of prematurity (ROP)

Area of Science:

• Ophthalmology
• Neonatology
• Pediatric Surgery

Background:

• Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
• Stage 4A ROP presents with retinal detachment, posing a risk of severe vision loss.
• Early and effective management is crucial to prevent long-term visual sequelae.

Purpose of the Study:

• To evaluate the anatomical success rate of laser therapy as a primary treatment for stage 4A retinopathy of prematurity (ROP).
• To determine if laser photocoagulation alone is sufficient for disease regression in this advanced ROP stage.

Main Methods:

• An observational, prospective case series involving 14 eyes of 7 infants diagnosed with stage 4A ROP.
• Infants underwent laser photocoagulation as the initial management strategy between January 2018 and July 2019.
• Data collected included gestational age, birth weight, post-menstrual age at laser treatment, and degree of retinal detachment. Follow-up extended to 6 months post-treatment.

Main Results:

• A high anatomical success rate of 92.85% (13 out of 14 eyes) was observed, defined as complete disease regression.
• One eye (7.15%) progressed to stage 4B ROP, necessitating lens-sparing vitrectomy (LSV).
• No cases required anti-vascular endothelial growth factor (anti-VEGF) therapy or conventional pars plana vitrectomy.

Conclusions:

• Laser photocoagulation is an effective first-line treatment for stage 4A retinopathy of prematurity, achieving high rates of anatomical success.
• This approach can obviate the need for adjunctive anti-VEGF therapy or surgical intervention in a majority of cases.
• Laser therapy offers a valuable, non-invasive management option for advanced ROP, preserving visual potential.