PURPOSETo assess the long-term refractive and biometric outcomes of diode laser-treated eyes in threshold retinopathy of prematurity (ROP). METHODSCycloplegic autorefraction and biometry (Zeiss IOLMaster) were performed, at a mean follow-up of 11 years, on 16 laser-treated eyes with threshold ROP and 9 comparison eyes with subthreshold untreated ROP. RESULTSThe laser-treated eyes had a mean spherical equivalent of Ϫ2.33 D with a mean astigmatic error of 1.38 D. The comparison eyes had a mean spherical equivalent of ϩ1.07 D with a mean astigmatic error of 0.42 D. This trend toward increased myopia in treated eyes did not achieve statistical significance ( p ϭ 0.08). The myopia in the laser group appeared to be slowly progressive in nature when compared with earlier refractive data for these patients. The laser-treated eyes had reduced anterior chamber depth (ACD) compared with the subthreshold eyes ( p ϭ 0.02). When physiologic accommodation was inhibited by cycloplegic drops, the anterior chamber deepened by 0.13 mm in the laser-treated eyes and by 0.06 mm in the comparison eyes. This effect of accommodation on ACD did not differ significantly between the two groups ( p ϭ 0.23). The laser-treated eyes and the comparison eyes did not differ significantly in terms of axial length, corneal power, corneal diameter, or lens power. However, both groups had steeper corneas, shallower anterior chambers, and shorter axial lengths when compared with historical full-term controls. CONCLUSIONSMyopia in premature infants requiring laser treatment for ROP is associated with a shallowing of the anterior chamber and a steepening of the cornea. Physiological accommodation is not impaired by laser therapy or by severe ROP. ( J AAPOS 2006;10: 454-459) P rematurity and retinopathy of prematurity (ROP) are well-established independent risk factors for myopia. [1][2][3][4] There have been reports that cryotherapy in threshold ROP contributes to the development of myopia and that laser photocoagulation, in comparison, produces less myopic shift. 5-7 However, Quinn et al felt that the cryotherapy did not result in additional myopia but that the high myopia was related to the cicatricial retinopathy or severity of ROP. 8 In recent times, laser photocoagulation has largely replaced cryotherapy as the established treatment modality for ROP. Davitt et al have shown no increase in myopia or high myopia, at 9 months, in laser-treated compared with untreated high-risk prethreshold ROP eyes in the Early Treatment of Retinopathy of Prematurity (ETROP) study. 9 The clinical objective of this study was to evaluate the long-term refractive outcome of threshold ROP eyes at a mean of 11 years after diode laser treatment, with particular attention to the role of the cornea, anterior chamber depth, axial length, and effective lens power in determining the refractive status.A comparison group with documented subthreshold ROP, which had regressed spontaneously without laser treatment, was also evaluated. Materials and MethodsAll premature babies who...
Laser treated eyes with favourable structural outcome have a good visual outcome. The results show a long term benefit from diode laser photocoagulation in preserving distance and near vision in eyes with threshold ROP.
This study is the first case series of torpedo maculopathy in the paediatric population. Contrary to previous reports of two distinct types of lesion on OCT representing different stages of the same disease, our case series indicates that Type 1 and Type 2 lesions are in fact different phenotypic entities both of which can occur at a young age. We also present the associated risk of choroidal neovascular membrane formation which is an important consideration for long term follow-up.
Aims: To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury. Methods: RetCam fundal images, cranial ultrasounds and magnetic resonance imaging (MRI) of 109 premature infants were analysed. The study cohort was divided into subgroups depending on the presence or absence of periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH). The control group consisted of infants with normal neuroimaging at term and 2 years of age. Using the image analysis software of the RetCam, optic disc diameter (ODD), optic disc area (ODA), and optic cup area (OCA) were measured at 33-34 weeks gestational age. As serial cranial ultrasonography had been performed, it was possible to date the brain injury in those infants with periventricular white matter (PVWM) damage. Results: Although there was a trend towards reducing ODD, ODA, and OCA with increasing severity of IVH, only the IVH 4 group differed significantly from the controls for these parameters (p = 0.002, p = 0.02, and p = 0.04, respectively). 44.4% of infants with grade 4 IVH had small discs. Only one patient had a large cup in a normal sized disc; this patient had IVH 4. In patients with PVWM damage, the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs. This difference was not significant (p = 0.23). Conclusions: Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia. We found no association between disc morphology and timing of brain injury.
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