Cataract and phthisis bulbi after laser photoablation for threshold retinopathy of prematurity

PURPOSE: To describe the visual and structural outcome of eyes that develop ed a dense cataract after laser photoablation for threshold retinopathy of prematurity. METHODS: A retrospective review of eight consecutive infants who developed dense cataract(s) after bilateral laser photoablation for threshold retinop athy of prematurity. Of the 10 eyes with cataract, five eyes were treated w ith a diode laser and five with an argon laser. The stage and zone of the r etinopathy of prematurity, number of burns applied, time of onset of the ca taract, clinical findings at the time of cataract surgery, and the course a fter cataract surgery were reviewed. RESULTS: Six eyes had zone 1 disease and four had zone 2 disease, The mean number of burns applied per eye was 2532 +/- 856 (range, 1400 to 4500), A c ataract was diagnosed a median of 13 weeks (range, 1 to 28 weeks) after las er photoablation. Nine of the 10 cataracts were sufficiently dense to precl ude a view of the fundus. All 10 eyes had clinical signs suggestive of an i nflammatory or ischemic process that included one or more of the following findings: corneal edema, pupillary membrane, iris atrophy, depigmentation o f ciliary processes, pigment on the anterior lens surface, posterior synech iae, hyphema, and shallow anterior chamber, Nine eyes under went cataract s urgery. Five of the 10 eyes had retinal detachment ranging in severity from stage 4A to stage 5 at the time of cataract surgery. Nine of the 10 eyes p rogressed to phthisis bulbi and no light perception, CONCLUSIONS: A dense cataract developing in the eye of an infant after lase r photoablation for threshold retinopathy of prematurity is associated with a poor visual prognosis, The constellation of associated clinical findings appears to be most consistent with anterior segment ischemia. (C) 2000 by Elsevier Science Inc. All rights reserved.