Structural and functional results of indirect diode laser treatment for retinopathy of prematurity from 1999 to 2003 in Kuwait

Abstract

PurposeThe purpose was to report the structural, visual, and refractive outcomes of infants treated for retinopathy of prematurity (ROP) with laser and to identify the risk factors for unfavorable outcomes.Materials and methodsThe charts of infants with severe ROP treated by diode laser in a tertiary center during the period April 1999 to November 2003 were reviewed. Treated infants were followed up for fundus examination, visual acuity assessment, and cycloplegic refraction. Data regarding ocular risk factors, like zones of ROP and the extent of extraretinal proliferations, and data regarding various systemic risk factors were collected. A minimum follow up of 6 months was needed for inclusion in the study of structural outcome. A minimum follow up of 24 months was needed for the study of visual and refractive outcomes. The outcomes measured were: rate of unfavorable structural outcome, unfavorable visual outcome (visual acuity < 20/40), and high myopia (myopia ≥ 5 diopters). The ocular and systemic risk factors were studied for their significance in the development of unfavorable outcomes.ResultsTwo hundred seventy eyes of 148 infants were treated for severe ROP, out of which 20 eyes (7.4%) had unfavorable structural outcome. Visual data were available for 149 eyes of 81 infants, of which 70 eyes (47%) had unfavorable visual outcome. Refractive data were available for 131 eyes of 72 infants, and high myopia was present in 23 (17.6%) eyes. Zone I disease was the significant risk factor for unfavorable structural (P < 0.0001), unfavorable visual outcome (P = 0.03), and for high myopia (P < 0.0001). Lower post-conceptional age at treatment was significant for unfavorable structural outcome (P = 0.03) and high myopia (P < 0.0001). Presence of sepsis (P = 0.029) and extraretinal proliferation ≥ 6 hours were significant for unfavorable structural outcome (P = 0.002).ConclusionROP in zone I was the most significant risk factor for all the unfavorable outcomes. Laser-treated ROP infants need long term follow up.

The long‐term outcome of extremely preterm (<28 weeks’ gestational age) infants with and without severe retinopathy of prematurity

“…Severe ROP is likely to affect ocular structures more so than subcortical or cortical structures; however, if ROP affects the initial processing of visual information, which in turn affects the development of the eye, then these changes may ultimately affect the way subcortical and cortical pathways develop such as ocular dominance columns or other visual pathway networks. Unsurprisingly, visual acuity remained significant after controlling for important confounders, given the reported relationship between ROP and refractive errors in this population (Kushner, ; Nissenkorn et al ., ; Quinn et al ., ; Snir et al ., ; Wani et al ., ; Yang et al ., ). Several studies have discussed the possible relationship between preterm birth, ROP, ocular growth, and development, with several mechanisms proposed as contributing factors (Fielder & Moseley, ; Fielder et al ., ).…”

“…Despite improvements in care, long‐term follow‐up of children with regressed ROP has shown that there is an increased incidence of strabismus, amblyopia and refractive errors, in particular myopia, compared with preterm infants without ROP and with full‐term infants (Kushner, ; Nissenkorn, Yassur, Mashkowski, Sherf, & Ben‐Sira, ; Quinn et al ., ; Snir, Nissenkorn, Sherf, Cohen, & Ben Sira, ; Wani et al ., ; Yang, Wang, Shih, & Hsu, ). For example, Nissenkorn et al .…”

Treatment success of laser therapy for retinopathy of prematurity in referred and non-referred patients

“…Low BW and small GA are known to be risk factors for the development of ROP (18) . Many previous studies included treatment groups mainly consisting of preterm patients weighing <1000 g and aged <28 weeks (10,(19)(20)(21) . In our study, consistent with previous reports, the average BW and GA in patients who received treatment were 900 g and 27 weeks, respectively; although these values were higher among referred patients, they were not statistically significant.…”

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

“…Zone 1 ROP, which is less sensitive to laser/cryotherapy and demonstrates poorer anatomic and visual outcomes (Good and Early Treatment for Retinopathy of Prematurity Cooperative, 2004), (Wani et al, 2013, Gunn et al, 2014, Gole et al, 2011, is correlated with vessel development by both vasculogenesis and angiogenesis, but vasculogenesis is only responsible for the formation of the primordial vessels in a small region surrounding the optic nerve head (Hughes et al, 2000) . Even within the central one third of the retina surrounding the optic disc, angiogenesis contributes to increasing vascular density once the primordial vessels are formed.…”

“…The worst visual outcomes occur in those infants with aggressive posterior ROP (AP-ROP) which typically occurs in Zone I. The visual outcomes for laser treatment of AP-ROP are generally poor (Wani et al, 2013, Gunn et al, 2014 despite good anatomical success rates (Sanghi et al, 2014). Early vitreous surgery has been advocated but the results remain poor especially if fibrovascular growth has already reached the vitreous base when surgery is performed (Azuma et al, 2013).…”