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Optimized technique of pattern laser photocoagulation for active retinopathy of prematurity

Session Details

Session Title: Vascular Diseases and Diabetic Retinopathy II

Session Date/Time: Friday 12/09/2014 | 11:00-13:00

Paper Time: 11:32

Venue: Boulevard C

First Author: : P.Volodin RUSSIA

Co Author(s): :    I. Iablokova   A. Borisova           

Abstract Details

Purpose:

One of the main trends in the treatment of active retinopathy of prematurity (ROP) is an early laser photocoagulation of avascular retina in the 'subthreshold' stage with 'plus'-disease, which significantly increases the level of requirements for precision and safety of laser surgery (ETROP,2003). Purpose – to evaluate the efficacy of optimized transpupillary pattern scanning laser photocoagulation for active stages of retinopathy of prematurity

Setting:

The academician S.N. Fyodorov Federal State Institution IRTC “Eye Microsurgery' (Moscow, Russia)

Methods:

The study involved 72 baby (142 eyes) in the active period of the retinopathy of prematurity (ROP) .The gestational ages at birth ranged from 25 to 32 weeks (mean 28,4±1,6 weeks). Birth weight - from 790 to 2250 g (mean 1120±118 g). 21 premature infants (41 eyes) were treated. Four babies (7 eyes) had 2 'subthreshold ' ROP with “plus-disease”, 6 children (12 eyes) - 3'subthreshold ' stage , 9 children ( 18 eyes) - 3'threshold' stage , and 2 babies (4 eyes) had aggressive posterior retinopathy of prematurity (AP -ROP) . Transpupillary slit-lamp delivered laser photocoagulation was performed on a scanning laser system «PASCAL Photocoagulator» (Optimedica, USA) with the use of different patterns (5x5, 4x4,3x3 and 2x2 dots). Laser parameters were established on the basis of fluence in a single pulse (0.7-1.1 J/cm2) at maximal spot diameter (400 microns) and minimal exposure of laser irradiation (0.02 sec.) and 0.25-0.5 φ spacing. Total amount of laser burns varied from 1250 to 2500.

Results:

Complete ROP regression was achieved in all 19 cases of premature infants with 'subthreshold ' stage, in 17 of 18 eyes – with 'threshold' ROP - (one eye required an additional laser) as a result of the optimized pattern laser treatment. Only one case with AP-ROP progressed after laser photocoagulation, necessitating early lens-sparing vitreous surgery.

Conclusions:

The use of PASCAL technology in the early treatment of active retinopathy of prematurity can significantly improve the efficacy (up 97.6%) and at the same time reduce the risk of complications due to the optimization of parameters of laser energy, which helps to improve the anatomical and functional outcomes of ROP .

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