Efficacy of Indirect Laser Photocoagulation in Cases with Retinopathy of Prematurity Presenting with Late Stage 3 Turning into Stage 4A

Abstract

Abstract Background Retinopathy of prematurity (ROP) is a preventable irreversible cause of blindness in children especially in developing countries. Early detection and management of type 1 ROP with intravitreal injection of Anti-VEGF or indirect laser photocoagulation is the cornerstone of preventing blindness from this disease. Screening programs for ROP are mandatory for picking cases early before retinal detachment develops. Standardized screening programs are still lacking in developing countries, like Egypt, so cases may present in later stages. Cases presenting too late with Stage 4 and 5 ROP are managed surgically with lens-sparing vitrectomy or lensectomy vitrectomy. A portion of the cases present at the transition from stage 3 into stage 4a ROP. Management of those cases with intravitreal anti-VEGF was reported to cause acute crunch and tractional retinal detachment. Management with laser photocoagulation has not been discussed before. Methods This is a retrospective interventional, non-comparative study. Review of records of ROP cases presenting after 4 weeks from delivery having stage 3 turning into stage 4a ROP for which indirect laser photocoagulation was done were collected in the period from January 2017 till May 2019. Gestational age, birth weight, postmenstrual age at first presentation, date of laser photocoagulation and number of sessions, fundus images showing initial regression and final regression and if any recurrences happened were recorded. Results Nine treatment naive eyes of five premature infants were included. Mean GA was 30.4+/- 1.5 wks (range, 28-32 wks; median, 31). Mean BW 1190+/- 174.6 gm (range, 900-1300; median = 1300). Mean PMA at presentation 42.5+/-5.7 wks (range, 38.5-52.5; median, 40.5). All 9 eyes presented with plus disease and highly elevated fibrovascular ridge with significant fibrous component in Zone II. 7 eyes (77.7%) had secondary retinoschisis, localized tractional retinal detachment. 2 eyes (22.2%) showed temporal dragging. All eyes received Indirect laser photocoagulation to the avascular retina (near confluent burns) one session for each eye. No skip areas were reported. 5 eyes (3 patients) were done under topical anesthesia and 4 (2 patients) under general anesthesia. All 9 eyes (100%) showed complete regression of ROP with release of traction, restoration of retinal anatomy at a mean of 3.7+/- 2.7 months (range, 2-8.5 months; median, 2.5 months). Conclusion Indirect laser photocoagulation is an effective treatment measure in premature infants presenting late with fibrovascular proliferation having high fibrous components and starting Stage 4a ROP in Zone II. Laser rather than IVI of Anti-VEGF may save those infants from crunch phenomenon and need for vitrectomy with final good anatomical and thus visual outcomes.