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Treatment of threshold retinopathy of prematurity
D A Deshpande1, M Chaturvedi, L Gopal
1Medical and Vision Research Foundations, Chennai, India.
Insights
Laser photocoagulation effectively manages threshold retinopathy of prematurity (ROP) in infants, leading to disease regression with minimal complications. Routine screening for ROP in premature infants is crucial for timely intervention and optimal outcomes.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Threshold ROP requires timely intervention to prevent severe visual loss.
Purpose of the Study:
- To report the experience and outcomes of managing threshold ROP using laser indirect photocoagulation and cryopexy.
- To evaluate the efficacy and safety of different treatment modalities for threshold ROP.
Main Methods:
- Treatment of threshold ROP in 45 eyes of 23 infants.
- Laser indirect photocoagulation as the preferred method, facilitated by scleral depression.
- Cryopexy used for cases with non-dilating pupils or medial haze, under general anesthesia.
Main Results:
- Successful regression of ROP achieved in 91.1% of eyes with no sequelae.
- Laser photocoagulation demonstrated excellent response and minimal treatment-related morbidity.
- Only 4 eyes with zone 1 disease progressed to stage 5 despite treatment.
Conclusions:
- Routine screening for ROP in infants up to 2,000 gm birth weight is essential.
- Laser photocoagulation is the preferred treatment for threshold ROP due to its efficacy and safety profile.
- Early detection and treatment of ROP significantly improve visual outcomes in premature infants.
Abstract:
This report deals with our experience in the management of threshold retinopathy of prematurity (ROP). A total of 45 eyes of 23 infants were subjected to treatment of threshold ROP. 26.1% of these infants had a birth weight of > 1,500 gm. The preferred modality of treatment was laser indirect photocoagulation, which was facilitated by scleral depression. Cryopexy was done in cases with nondilating pupils or medial haze and was always under general anaesthesia. Retreatment with either modality was needed in 42.2% eyes; in this the skip areas were covered. Total regression of diseases was achieved in 91.1% eyes with no sequelae. All the 4 eyes that progressed to stage 5 despite treatment had zone 1 disease. Major treatment-induced complications did not occur in this series. This study underscores the importance of routine screening of infants upto 2,000 gm birth weight for ROP and the excellent response that is achieved with laser photocoagulation in inducing regression of threshold ROP. Laser is the preferred method of treatment in view of the absence of treatment-related morbidity to the premature infants.