Título

LONG-TERM VISUAL, REFRACTIVE, RETINAL AND ORTHOPTIC OUTCOMES OF DIODE LASER TREATMENT FOR RETINOPATHY OF PREMATURITY (ROP), WITH ANALYSIS OF RISK FACTORS FOR POOR VISUAL OUTCOME: A SINGLE CENTER CASE SERIES

Introdução / Purpose

We examined long term clinical outcomes after diode laser treatment for ROP with diode laser in a single center, with reference to landmark trials. We also analyzed the relative risk of poor visual outcome with patient factors including brain injury, and high myopia.

Material e Método / Methods

We reviewed ophthalmology and neonatology files of patients treated between 2009 and 2016 who continued under local review. Patients had annual visual and orthoptic assessment, cycloplegic refraction, and ophthalmologist review. We recorded best corrected visual acuity (BCVA), refractive and orthoptic findings at last visit, and any retinal anomaly. Good vision was defined as binocular BCVA of 20/40 or better. Unfavorable VA was below 1.85 cycles per degree. Perinatal morbidity was analysed. Statistical analysis of results was performed using MedCalc software.

Resultados / Results

22 patients (44 eyes) were identified. Median postmenstrual age at birth was 25 weeks (range: 23-29). Median birthweight was 710g (479-1210g). Perinatal morbidity included: brain injury (41%), lung disease (64%), anemia (9%). Mean follow-up duration was 3.4 years (range: 0.7-6.6 years). No new retinal anomaly was found. 76% of patients achieved good vision. 2 eyes (5%) of 1 patient achieved unfavorable VA. Mean spherical equivalent in treated eyes was -0.375 diopters (-13.50 to +13.50). 8% of patients developed binocular high myopia (-8D or greater). Failure to achieve good vision was associated with brain injury (relative risk: 3.6, p=0.0008), binocular high myopia (RR 6.3, p=0.018), abnormal ocular motility (RR 6.4, p=0.0792) and lung disease (RR 2.1, p=0.49).

Discussão e Conclusões / Discussion

There was a lower incidence of unfavorable VA (5% vs 14%) and retinal outcomes (0% vs 9%) compared to the ET-ROP trial. Fewer eyes (12%) developed high myopia than in the BEAT-ROP laser arm (42%). Poor vision correlated with brain injury and high myopia, not retinal status. Neurological factors may be implicated and should be considered in assessing prognosis after ROP treatment.

Palavras Chave

ROP, retinopathy, prematurity, laser, diode, ET-ROP, BEAT-ROP

Area

SURGICAL RETINA