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Diode laser photocoagulation for retinopathy of prematurity: outcomes after 7 years of treatment

Session Details

Session Title: Quick Fire Free Paper Session 04

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:15

Venue: Hall C (Level 1)

First Author: S.Nicoara ROMANIA

Co Author(s):    C. Stefanut   I. Irimescu   C. Cristian   G. Zaharie     

Abstract Details

"Purpose:

This study has three objectives: 1. To evaluate the number of premature infants who needed laser photocoagulation for retinopathy of prematurity (ROP) for a 7 years period of time. 2. To describe the evolution of ROP in the new born infants from the study sample, translated by: rate of ROP progression, frequency of re-treatment, complication rate, structural outcomes. 3. To identify the individual factors associated with the outcomes of laser therapy among the new born infants from the study sample.

Setting:

The study was carried out at the “Iuliu Hatieganu” University of Medicine and Pharmacy from Cluj-Napoca, Romania, involving the Ophthalmology and the Neonatology Departments. All the laser therapies were performed by two ophthalmologists in the Neonatology Department.

Methods:

This is a non-comparative, consecutive, interventional, retrospective case series. We analized retrospectively the files of all the infants who received indirect diode laser photocoagulation for ROP, between January 1st 2006 – December 31st 2012. We undertook the laser treatment in the following situations: zone 2 stage III ROP, zone 1 stage III ROP and aggressive posterior disease (APD). Treatment was carried out within 48 hours from the diagnosis, with a portable diode laser photocoagulator ( 810nm). All the cases were treated under sedation. The entire surface of the avascular retina was covered with laser spots, in a confluent manner. The first evaluation took place 6 – 7 days after the treatment and continued every 5 – 6 days, until there was evidence of ROP regression. If laser re-treatment was necesarry, it was carried out 7 days after the first laser session. The statistical analyses were performed with the program SPSS-15. There were calculated frequencies for the following independent variables: sex of the preterm infant, gestational age, birth weight, postnatal and postmenstrual age at treatment, classification of ROP. The univariate logistic regression analysis was used. The chi square test and the p values were considered in order to interpret the results.

Results:

During the last 7 years we performed diode laser photocoagulation for ROP in 83 infants: 45 males (54.22%) and 38 females (45.78%). Gestational ages varied between 24 and 33 weeks (median 27 weeks) and birth weights between 600g – 1700g (median 1130g). The postnatal age at treatment varied between 5 - 13 weeks (median 8 weeks) and the postmenstrual age at treatment, between 32 – 41 weeks (median 37 weeks). Retinal laser photocoagulation was bilateral in 77 cases and unilateral in 6 cases. The 160 lasered eyes were classified in two categories: classic disease (stage III ROP in zones 1 or 2) – 136 eyes (85%) and APD– 24 eyes (15%). ROP regressed after laser photocoagulation in 141 eyes (88.12%). The success rate was 94.11% in the classic ROP and 54.16% in APD. The chi square test proved that the outcome of the laser treatment was significantly worse in APD as compared to the classic form of ROP (OR = 13.53, RR = 7.79, p < 0.001). The statistical analyses showed that the gestational age, the birth weight, the sex of the preterm infant, the postnatal age and the postmenstrual age at treatment did not correlate with the success rate.

Conclusions:

1. For a 7 years period of time (January 2006 – December 2012), we treated by indirect diode laser photocoagulation a number of 83 premature infants, totalizing 160 eyes. They were classified in the classic form ROP – 136 eyes (85%) and aggressive posterior ROP – 24 eyes (15%). 2. ROP regressed after the laser treatment in 141 eyes (88.12%). The success rate differs according to the ROP category: 94.11% in classic ROP and 54.16% in aggressive posterior ROP. 3. The only factor that influenced the post laser result on our series was the ROP type: the chi square test proved that the outcome was significantly worse in aggressive posterior ROP as compared to the classic form ROP (OR = 13.53, RR = 7.79, p < 0.001). 4. The poor results of the laser treatment in aggressive posterior ROP justify the replacement of this therapy by the intraocular injections with anti-VEGF agents, in this particular form of the disease, in our clinical practice."

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