TRANSSCLERAL VS TRANSPUPILLARY DIODE-LASER PHOTOCOAGULATION FOR THE TREATMENT OF THRESHOLD RETINOPATHY OF PREMATURITY

Objective: To evaluate the efficacy and safety of transscleral diode l aser photocoagulation for the treatment of threshold retinopathy of pr ematurity (ROP).Patients: Fifty eyes of 25 preterm infants (birth weig ht, 510-1200 g [864+/-178 g {mean+/-SD}]; 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 trea ted transsclerally while the fellow eye had transpupillary coagulation using the laser indirect ophthalmoscope. Follow-up ranged from 2 to 2 2 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 e yes treated transsclerally, ROP regressed after a single or a second l aser treatment and the outcome was a flat, attached retina. One eye (4 %) with disease in zone I failed to improve after transscleral laser t reatment and ROP progressed to stage 4B with a partially attached reti na, 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 eff ects leg, cataract formation) in the anterior segments of the eyes. Co nclusions: The results suggest that transscleral diode laser coagulati on is as effective in the treatment of threshold ROP as transpupillary diode laser photocoagulation. Only minor side effects were noted. Tra nsscleral diode laser photocoagulation seems to be an advantageous tre atment method if transpupillary treatment bears an increased risk of c ataract formation.