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Diode-laser photocoagulation for zone 1 threshold retinopathy of prematurity
A Capone1, R Diaz-Rohena, P Sternberg
1Department of Ophthalmology, Emory University, Atlanta, Georgia.
Insights
Diode laser treatment effectively addresses threshold retinopathy of prematurity in zone 1 for infants. This method shows promise for improving outcomes in this condition.
Area of Science:
- Ophthalmology
- Neonatal Care
- Medical Technology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Zone 1 ROP, particularly threshold ROP, requires timely and effective intervention.
- Previous treatments like cryoablation have limitations.
Purpose of the Study:
- To evaluate the efficacy and safety of diode-laser indirect ophthalmoscopy for treating zone 1 threshold retinopathy of prematurity.
- To compare diode laser treatment with existing modalities.
Main Methods:
- Diode-laser indirect ophthalmoscopy was used to treat 30 eyes of 17 infants with zone 1 threshold ROP.
- Mean follow-up duration was 31.2 weeks.
- Treatment involved peripheral retinal photoablation.
Main Results:
- A favorable outcome was achieved in 83.3% of eyes (25/30).
- Retreatment was necessary in 6.7% of eyes (2/30) for persistent plus disease.
- Retinal detachments occurred in 16.7% of eyes (5/30), with two progressing to Stage 5 (total retinal detachment).
- Late complications included nystagmus (4/14 infants) and strabismus (6/14 infants).
Conclusions:
- Diode-laser photoablation is an effective treatment for zone 1 threshold retinopathy of prematurity.
- Advantages include portability, ease of use, treatment precision, and minimal inflammation.
- Further research into long-term visual outcomes and potential complications is warranted.
Abstract:
We used the diode-laser indirect ophthalmoscope in the treatment of 17 (30 eyes) infants with zone 1 (a circle centered on the optic disk with a radius of twice the distance from the disk to the fovea) threshold retinopathy of prematurity (at least five continuous or eight cumulative 30-degree sectors [clock hours] of ridge with extraretinal fibrovascular proliferation in the presence of plus disease). Mean follow-up was 31.2 weeks. Two eyes (6.7%) required retreatment of missed areas that had persistent plus disease (enlarged posterior veins and tortuous arterioles). A favorable outcome was attained in 25 eyes (83.3%). Five eyes (16.7%) developed retinal detachments, three of which remained stable at Stage 4A (extrafoveal retinal detachment) and two of which ultimately progressed to Stage 5 (total retinal detachment). Both eyes that went on to Stage 5 had severe posterior pole hemorrhages at the time of treatment. Two eyes that developed retinal detachments (one, stage 4A and one, stage 5) had rhegmatogenous components. Among 14 infants followed up for more than three months, four developed nystagmus, and six developed strabismus. In contrast to cryoablation, diode-laser photoablation of the peripheral retina was found to be an effective treatment for threshold retinopathy of prematurity located in zone 1. Portability and ease of use of the laser system, precision of treatment, and minimal postprocedural adnexal inflammation are further advantages of this therapeutic modality.
