Long-Term Refractive and Biometric Outcomes Following Diode Laser Therapy for Retinopathy of Prematurity

Abstract

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...

Ocular Morbidity of Preterm Infants Screened for Retinopathy of Prematurity at 2 Years of Age – A Prospective Follow up Study

“…But this difference was not statistically significant. This is not in agreement with recent studies which have dealt with the possibility of laser treatment contributing to the occurrence of myopia [14][15][16] But on analysing the degree of Myopia, it was higher in the treated group than in the spontaneously regressed group, thus outlining that laser treatment was significant in determining the severity of Myopia. The ETROP study had also reported that 80% of threshold ROP infants and 65% of treated high risk pre-threshold infants had myopia.…”

Refractive Error in Patients with Retinopathy of Prematurity after Laser Photocoagulation or Bevacizumab Monotherapy

“…Previous studies have shown that myopia of prematurity that develops secondary to arrested development of the anterior segment significantly influences the anatomy of optical components, including the development of a steeper corneal curvature, shallower anterior chamber, and thicker lens [14,23,24,25,26]. Most studies have confirmed that ROP severity is a major factor contributing to the refractive error, and cryotherapy was found to induce myopia more frequently than laser photocoagulation in treated threshold ROP eyes [15,16,17,26].…”

Long-term visual outcomes of laser-treated threshold retinopathy of prematurity: a study of refractive status at 7 years

“…Various hypotheses, including anomalies of corneal diameter and curvature, shallow anterior chamber, axial length, and lens power, have been suggested. 12,14,15 Some of these abnormalities might relate to the disturbed ocular growth in infants with ROP, and high crystalline lens power is suggested to be the predominant contributing factor of myopia in eyes with ROP. 13,16 Tasman et al 17 found that patients with ROP and a high degree of myopia had a higher rate of retinal detachment in latter life.…”