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Early treatment of posterior retinopathy of prematurity: a controlled trial
J F Vander1, J Handa, J A McNamara
1Wills Eye Hospital Retina Service, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Insights
Early laser treatment for posterior retinopathy of prematurity (ROP) shows outcomes comparable to delayed treatment. Most infants with prethreshold ROP progress to threshold disease rapidly, often within a week.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Medical Research
Background:
- Posterior retinopathy of prematurity (ROP) is a leading cause of vision loss in premature infants.
- The natural history and optimal timing for intervention in prethreshold posterior ROP remain critical areas of investigation.
Purpose of the Study:
- To evaluate the efficacy of early laser treatment for posterior ROP.
- To gather data on the natural progression of posterior ROP in infants.
Main Methods:
- A prospective, multicenter, randomized trial involving 19 infants with prethreshold posterior ROP.
- Infants were randomized to immediate laser photocoagulation or observation, with delayed treatment if threshold disease developed.
- Outcomes, including structural results and adverse effects, were assessed at 3 months.
Main Results:
- Unfavorable structural outcomes occurred in 16% of eyes with early treatment versus 18% with delayed treatment.
- A high proportion (88%) of control eyes progressed to threshold disease, often within one week.
- Eyes with posterior ROP and extraretinal fibrovascular proliferation consistently progressed to threshold disease.
Conclusions:
- Early laser treatment for prethreshold posterior ROP offers outcomes comparable to delayed treatment.
- There is a significant and rapid progression rate from prethreshold to threshold ROP, emphasizing the need for close monitoring.
Objective:
The purpose of the study is to assess the possible benefits of early laser treatment for posterior retinopathy of prematurity (ROP) and to provide data concerning the natural history of posterior ROP.
Design:
The study design was a prospective, multicenter, randomized trial.
Participants:
A total of 19 infants with prethreshold posterior ROP were studied.
Intervention:
Randomization to immediate indirect laser photocoagulation or observation, with application of laser photocoagulation for those control eyes reaching threshold disease, was performed.
Main Outcome Measures:
Patients were assessed at 3 months and the anatomic outcome recorded along with any adverse treatment effects.
Results:
An unfavorable structural outcome developed in 3 (16%) of 19 early treatment eyes compared with 3 (18%) of 17 for those treated only if threshold disease was reached. Of the 17 control eyes, 15 (88%) reached threshold disease. Progression to threshold occurred within 1 week in all but two eyes. All 12 control eyes with posterior ROP and any amount of extraretinal fibrovascular proliferation progressed to threshold disease.
Conclusions:
Although the number of patients studied is too small to reach statistical significance, the likelihood of a favorable outcome for eyes with prethreshold posterior ROP treated immediately with laser photocoagulation is comparable to that obtained by withholding treatment until threshold disease is reached. There is a high probability of progression from prethreshold to threshold disease, usually within 1 week or less.
