Laser Treatment Halts Retinopathy in Extreme Prematurity

Linda Roach

April 04, 2013

An examination of 18 years of records on treating retinopathy of prematurity (ROP) with diode laser photocoagulation has shown that it stops disease progression and leads to good visual outcomes for most of today's extremely premature infants, an Australian research group reports.

"For infants less than 26 weeks [gestational age], we have shown that the use of diode laser therapy offers similar structural and visual outcomes to that of low and very low birth weight infants with ROP," David J. Gunn, MBBS, from the Department of Ophthalmology, Royal Children’s Hospital, Brisbane, Australia, and colleagues write in an article published in the March issue of Clinical and Experimental Ophthalmology.

The researchers based their conclusion on a retrospective review of clinical outcomes among 373 preterm infants, born from 1992 through 2009, who were screened for ROP after admission to the Royal Brisbane and Women’s Hospital Neonatal Intensive Care Unit. The children's gestational ages were between 23 and 25.6 weeks, and their mean birth weight was 711.4 g.

Of the 373 infants who were screened for ROP, 128 eyes in 66 (17.7%) infants, showed high-risk prethreshold or threshold disease, which was treated with the diode laser. At 6 months after treatment, ROP regressed after a single treatment in 91% of the prethreshold eyes and in 85% of the threshold cases, the researchers found.

In the children whose vision could be assessed with a Snellen chart (40 eyes), the testing showed uncorrected visual acuity of 6/12 (20/40) or better in 73% (29 eyes). By comparison, 34.6% of treated children who achieved this level of visual acuity after 6 years of follow-up in the Early Treatment for Retinopathy of Prematurity Study (ETROP).

All exams and diode laser treatments in the infants were performed by a single pediatric ophthalmologist, Glen Gole, MD, FRANZCO, professor of ophthalmology at the University of Queensland, Australia, and head of the ophthalmology department at Royal Children's Hospital in Brisbane.

In an interview, Dr. Gole told Medscape Medical News that the longevity of the study and the delivery of care by a single surgeon distinguish this study from previously published studies.

"It shows a changing trend in how we treat these children [during an 18-year period], and it also shows that treatment with laser, for even these small babies, is a pretty good treatment for almost all of them," he explained. Nonetheless, Dr. Gole cautioned against unnecessary laser treatment.

"There was a time when every 23-weeker ended up being lasered. That's certainly not the case now," Dr. Gole said. "The amount of laser you do has a rough correlation with the amount of myopia you produce. So it's not a perfect treatment."

During the last 2 decades, the diode laser procedure has largely replaced cryotherapy as the preferred method of ROP treatment in developed countries, Michael X. Repka, MD, MBA, who formerly chaired the Pediatric Eye Disease Investigator Group, told Medscape Medical News.

Dr. Repka, professor of ophthalmology and pediatrics at Johns Hopkins University in Baltimore, Maryland, added that in places where diode lasers are unaffordable or unavailable, cryotherapy remains an effective treatment option.

"The field has moved beyond cryotherapy by consensus for treatment of ROP for many reasons, including ability to treat posteriorly, comfort[, and] facility, but it is important [to remember] that cryo can work if that is what is available," Dr. Repka explained.

"This is just another paper that shows that laser ablative therapy has excellent results for type 1 and threshold types of acute ROP," he noted.

The authors have disclosed no relevant financial relationships. Dr. Repka is a paid physician member consultant to the American Academy of Ophthalmology, serving as its medical director for governmental affairs, and receives grant support from the National Eye Institute.

Clin Experiment Ophthalmol. 2013;41:159-166. Abstract