Technical aspects of laser treatment for acute retinopathy of prematurity under topical anesthesia

Jalali, Subhadra; Azad, Rajvardhan; Trehan, Hemant; Dogra, Mangat R; Gopal, Lingam; Narendran, Venkatapathy

doi:10.4103/0301-4738.71689

Cited by 61 publications

(54 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are different views on the direct treatment of the ridge between the vascular and avascular parts of the retina 8,12,[12][13][14][15][16][17][18][19][20] . Near confluent laser photocoagulation, which was used in the CALCR procedure, seems to be more effective than the usage of individual laser spots.…”

Section: Discussionmentioning

confidence: 99%

A new modified technique for the treatment of high-risk prethreshold ROP under the direct visual control of RetCam 3

Timkovič¹,

Němčanský²,

Cholevík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

A new modified technique for the treatment of high-risk prethreshold ROP under the direct visual control of RetCam 3

Timkovič¹,

Němčanský²,

Cholevík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

“…More details further in our article on technique of laser for ROP under topical anaesthesia. 4 FFA may be difficult to get in a 'hot eye' due to media haze and poor pupillary dilatation and also one may not be able to target the laser exactly in the area we see on FFA at that stage. Hence I would not consider FFA at first stage where a lot of avascular retina needs to be ablated quickly and targeted laser is not the approach at that point of time.…”

Section: Wwwdjoorgin E-issn 0976-2892mentioning

confidence: 99%

Retinopathy of Prematurity

Chandra¹

2015

DJO

View full text Add to dashboard Cite

Retinopathy of Prematurity Delhi J Ophthalmol 2015; 25 (3): 198-206 Retinopathy of Prematurity (ROP) 1 is an important cause of childhood blindness in our country. With mushrooming of NICU's saving the smallest of babies, a steep rise in number of ROP cases is occurring across the country. Lack of awareness among ophthalmologists and neonatologists is leading to a huge increase in ROP related blindness, which poses a huge socio-economic burden on the community. 2 As more ophthalmologists get trained in ROP care, they encounter complex situations which need expert advice. These Ophthalmic Deliberations share the opinions and views of the top ROP experts in the country on selected ROP case scenarios. Their experience in managing such cases will surely benefit the ROP beginner as well as the seasoned ROP specialist.Parijat Chandra -Case 1: A preterm baby born at 29 wks gestational age (GA) and 865g birth weight (BW) presents at 33 weeks post conceptional age. The child has a history of sepsis, jaundice and assisted ventilation. The pupils dilate poorly and have dense tunica vasculosa lentis. Only the posterior pole was visualized with plus disease and was suggestive of zone I Aggressive Posterior ROP (APROP) in both eyes (Figure 1). Rajvardhan Azad-The challenges to performing laser include -small pupils, hazy media, dense tunica vasculosa lentis and absence of clear demarcation line. As we can see the posterior pole, and since it is a Zone 1 disease -one should take up this case on an urgent basis. To delineate the demarcation between vascular and avascular retina, an ideal approach will be to do Retcam assisted fundus fluorescein angiography (FFA) as we need to perform laser urgently. 3 While doing laser, all avascular areas should be knocked off preferably in one sitting in both eyes. However, if hazy media precludes the view of fundus, which is not in this case, one can inject AntiVEGF agents followed by laser after 2-3 days. Rajvardhan Azad MD, FRCSEDMangat Dogra-My first choice will be confluent laser photocoagulation with diode/532 laser delivered through laser indirect ophthalmoscope (LIO) delivery system. Both laser wavelengths work well in the presence of tunica vasculosa lentis without causing any lens opacities. Non dilating pupils mostly dilate well after scleral depression due to mechanical stretching during laser treatment.In case laser treatment is not possible or inadequate due to media haze, I would inject intravitreal Bevacizumab (Avastin) and wait for media to improve. I always prefer to perform laser to the entire avascular retina after intravitreal injection of Avastin. This helps to prevent recurrence of ROP in long term follow up. FFA helps to delineate entire areas of avascular retina in the initial stage and later to monitor retinal changes induced by Avastin. However, all cases after intravitreal anti-VEGF require close and long term follow up as compared to eyes undergoing laser treatment.Subhadra Jalali -Laser is challenging but can be always done. Dilate with 1% Tropicamide and 2...

show abstract

“…Additionally, laser treatment for ROP has been started to be practised under topical anesthesia. 14,15 Presence of BP makes it more difficult when treating the lower quadrants. 16 BP and unwanted ocular movements may increase the risk of accidental ablation of the posterior retina.…”

Section: A Significant Challenge During Retinopathy Of Prematurity Scmentioning

confidence: 99%

A Significant Challenge During Retinopathy of Prematurity Screening: Bell's Phenomenon

Şekeroğlu¹,

Hekimoğlu²,

Petriçli³

et al. 2015

Turkiye Klinikleri J Ophthalmol

View full text Add to dashboard Cite

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To evaluate the expression of Bell's phenomenon (BP) in premature infants and to discuss the effects of BP expression on retinopathy of prematurity screening examination. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Consecutive infants admitted for retinopathy of prematurity screening examination were all recruited. The expression of BP was evaluated just after the insertion of the blepharostat and during illumination of the eye by the binocular indirect ophthalmoscopic light beam. BP was recorded as grade 0 when there is no expression, grade 1 when partial response is present (the center of pupil visible) and grade 2 when full response is present (the center of pupil is not visible). R Re es su ul lt ts s: : A total of 152 infants with a mean gestational age of 31.4±2.8 weeks and a mean birth weight of 1705.0±543.3 g. were enrolled in the study. Fourty-two (30.3%) grade 0, 70 (46.0%) grade 1 and 36 (23.7%) grade 2 responses were observed just after the insertion of the blepharostat. After illumination of the eye with the indirect ophthalmoscope, 31 (20.4%) grade 0, 60 (39.5%) grade 1 and 61 (40.1%) grade 2 responses were observed. No significant association was found between the gestational age and the frequency of BP just after insertion of the blepharostat. (p=0.856) However, there was a statistically significant difference of the expression frequency of BP between different age groups during illumination with the light of binocular indirect ophthalmoscope (p=0.008). C Co on nc cl lu us si io on n: : BP is commonly encountered in premature infants during retinopathy of prematurity screening examination. It should be taken into consideration during screening examination and laser treatment under topical anesthesia in order to prevent conjunctival injury and anterior segment ischemia.K Ke ey y W Wo or rd ds s: : Infant, premature; retinopathy of prematurity Ö ÖZ ZE ET T A Am ma aç ç: : Prematüre bebeklerde Bell fenomeni (BF) görülme sıklığını ve bu durumun prematüre retinopatisi tarama muayenesi sırasında neden olabileceği sonuçları tartışmak amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Prematüre retinopatisi tarama muayenesi için başvuran bebeklerde blefarosta takılmasını ve indirekt oftalmoskop ışığının göze tutulmasını takiben BF varlığı değerlendirildi. Yanıt alınamayan olgular evre 0, kısmi yanıt alınan olgular (pupil merkezi görülen) evre 1 ve tam yanıt alınan olgular (pupil merkezi görülemeyen) ise evre 2 olarak kaydedildi. B Bu ul lg gu ul la ar r: : Ortalama gestasyonel yaşı 31,4±2,8 hafta ve doğum ağırlığı 1705,0±543,3 g olan 152 bebek çalışma kapsamına alındı. Blefarosta takılmasını takiben 42 (%30,3) bebekte evre 0, 70 (%46,0) bebekte evre 1 ve 36 (%23,7) bebekte evre 2 yanıt izlendi. İndirekt oftalmoskop ışığı ile 31 (%20,4) bebekte evre 0, 60 (%39,5) bebekte evre 1 ve 61 (%40,1) bebekte evre 2 yanıt izlendi. Gestasyonel yaş ile blefarosta takılmasını takiben ortaya çıkan BF görülme sıklığı arasında ista...

show abstract

Technical aspects of laser treatment for acute retinopathy of prematurity under topical anesthesia

Cited by 61 publications

References 13 publications

A new modified technique for the treatment of high-risk prethreshold ROP under the direct visual control of RetCam 3

A new modified technique for the treatment of high-risk prethreshold ROP under the direct visual control of RetCam 3

Retinopathy of Prematurity

A Significant Challenge During Retinopathy of Prematurity Screening: Bell's Phenomenon

Contact Info

Product

Resources

About