ROP laser treatment based on fluorescein angiography classification

Abstract

PurposeTo report laser treatment of babies with retinopathy of prematurity (ROP) based on diagnostic signs in the fluorescein angiography images (FA). FA reliability and accuracy were previously demonstrated [EJ opht 2013; 23(6):881–886].MethodsThis is a cross‐sectional study with retrospective diagnostic data from 72 eyes of 36 premature infants (average gestational age: 26 weeks; average birth weight: 742 g) with Type 1 ROP stage 2 evaluated by RetCam3 and FA. RetCam funduscopic images were compared with FA images. A grid with ocular fundus divided into 3 concentric zones (ICROP 1984–87) and into 4 quadrants centered on optic nerve was superimposed on 360° retina photomontages (Photoshop) obtained from the RetCam and FA images. The FA diagnostic signs included leakage, ischemic areas, peripheral plus disease and vascular anomalies. These signs were not detectable in the RetCam images of the same patients. A scoring system was derived considering the presence (1) or absence (0) of the diagnostic signs. The scores of each single sign were summed to obtain a total score for each quadrant. These scores were then summed to get the global score of each eye. Three different fluorangiographic categories were defined in ROP stage 2 (fundoscopic image): mild (score < 4), medium (4 ≤ score ≤ 10) and severe (score > 10).The decision of either laser‐treatment or observation was made based on this FA classification.Results58 eyes were classified as severe stage 2, 22 as medium and 14 as mild. Complete (360°) and partial (90° or 180°) laser‐treatments were performed in severe and medium ROP, respectively; for mild ROP closely observation was preferred.ConclusionsFA classification is a useful tool to detect early signs of ROP progression to threshold disease. It improves treatment timing and extension in order to obtain the best anatomical and functional outcomes.