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Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment
Shilpi H Narnaware1, Prashant K Bawankule2, Dhananjay Raje3
1Consultant Vitreo-retina & ROP Specialist, Sarakshi Netralaya, Rajiv Nagar, Wardha Road, Nagpur 440025, Maharashtra, India.
Insights
Laser therapy is highly effective for aggressive posterior retinopathy of prematurity (APROP), achieving a 94.64% success rate. This treatment offers a safe, one-time solution without systemic side effects, making it a primary option for APROP.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Aggressive posterior retinopathy of prematurity (APROP) is a severe form of retinopathy of prematurity.
- Effective treatment is crucial to prevent vision loss in premature infants.
- Laser therapy is a well-established treatment modality for retinopathy of prematurity.
Purpose of the Study:
- To evaluate the success rate of laser therapy as a primary treatment for APROP.
- To determine if laser therapy is a viable alternative to anti-VEGF or surgery for APROP.
Main Methods:
- A prospective case series included 56 eyes of 28 preterm infants diagnosed with APROP.
- Infants were categorized by gestational age, birth weight, and postmenstrual age at treatment.
- Treatment success was defined as complete disease regression without requiring anti-VEGF or vitrectomy.
Main Results:
- The overall success rate of laser therapy for APROP was 94.64% (53 out of 56 eyes).
- Infants requiring additional treatment were primarily those with lower gestational ages and birth weights.
- Specific cases needing further intervention included infants <28 weeks GA, <1000 gm BW, and those treated at 30-33 weeks PMA.
Conclusions:
- Laser therapy demonstrates a high success rate as a primary treatment for APROP.
- It remains a valuable primary treatment option, even with the availability of anti-VEGF therapies.
- Laser therapy offers a safe, one-time treatment with no systemic side effects or concerns about avascular zones.
Purpose:
To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases.
Methods:
This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): 28 (n = 7), 28-30 (n = 11), 30 (n = 10). BW (in grams): 1000 (n = 8), 1000-1200 (n = 10), 1200 (n = 10). PMA (in weeks): 32 (n = 6), 32-34 (n = 18), 34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy.
Results:
The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were 28 weeks of GA (one eye) and 28-30 weeks (two eyes). One baby (one eye) was 1000 gm and the other (two eyes) was 1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes).
Conclusion:
In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.
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