Transscleral vs transpupillary diode laser photocoagulation for the treatment of threshold retinopathy of prematurity
V. Seiberth, O. Linderkamp and I. Vardarli
Department of Ophthalmology, Klinikum Mannheim, Faculty for Clinical Medicine of the University of Heidelberg, Germany.
OBJECTIVE: To evaluate the efficacy and safety of transscleral diode laser
photocoagulation for the treatment of threshold retinopathy of prematurity
(ROP). PATIENTS: Fifty eyes of 25 preterm infants (birth weight, 510-1200 g
[864+/-178 g inverted question markmean+/-SD inverted question mark];
gestational age, 24-29 weeks [26.7+/-1.7 weeks]) with threshold ROP were
treated with diode laser photocoagulation (wavelength, 810 nm). One eye of
each infant was treated transsclerally while the fellow eye had
transpupillary coagulation using the laser indirect ophthalmoscope.
Follow-up ranged from 2 to 22 months (10.0+/-5.3 months). MAIN OUTCOME
MEASURE: The regression of acute ROP and the incidence of adverse treatment
effects. RESULTS: In 25 (100%) of the eyes treated transpupillarly and in
24 (96%) of the eyes treated transsclerally, ROP regressed after a single
or a second laser treatment and the outcome was a flat, attached retina.
One eye (4%) with disease in zone I failed to improve after transscleral
laser treatment and ROP progressed to stage 4B with a partially attached
retina, although additional retinal detachment surgery with an encircling
band was performed. No adverse side effects as a result of diode laser
treatment were noted except for a small amount of retinal-preretinal
bleeding in the ridge in 9 (36%) of the transsclerally and in 5 (20%) of
the transpupillarly coagulated eyes. There were no adverse side effects
(eg, cataract formation) in the anterior segments of the eyes. CONCLUSIONS:
The results suggest that transscleral diode laser coagulation is as
effective in the treatment of threshold ROP as transpupillary diode laser
photocoagulation. Only minor side effects were noted. Transscleral diode
laser photocoagulation seems to be an advantageous treatment method if
transpupillary treatment bears an increased risk of cataract formation.
