Posterior laser barrage in advancing retinopathy of prematurity: A prospective randomized study

Abstract

Purpose: To compare the outcomes of conventional laser photocoagulation versus additional posterior barrage laser in advanced stage 3 retinopathy of prematurity (ROP). Methods: A total of 20 infants with bilateral symmetric zone 2 stage 3 advancing ROP were treated with conventional laser treatment followed by randomization of one eye to receive additional posterior retinal laser treatment. Disc–fovea and inter-arcade distance was measured. The patients were followed up prospectively for 3 months. Structural and functional outcomes and safety profile were analyzed. Results: 18/20 (90%) eyes in the study group and 19/20 (95%) eyes in the control group achieved regression of disease. Faster and complete regression was observed at 4 weeks after posterior laser compared to the control group ( P = 0.024). Disc–fovea and inter-arcade distance was comparable in both groups. Conclusion: Additional posterior barrage laser is a safe technique that led to faster and more complete regression in eyes with advancing ROP. Final regression profile was comparable in both treatment modalities.

Posterior to the ridge laser in zone 2 stage 3 retinopathy of prematurity with plus disease: Efficacy and safety

“…Tewari et al . [ 11 ] conducted a prospective study of 20 eyes with stage 3 ROP with plus disease in zone 2 (having more than 4 clock hours of temporal ridge), treated with a posterior laser, and reported a 90% favorable outcome. The mean time to regression was 4.77 ± 2.48 weeks for eyes receiving additional posterior laser, which was significantly faster than 5.37 ± 2.38 weeks reported for eyes treated by conventional laser.…”

“…[ 5 ] Posterior to the ridge laser is a strategy, which has been reported in a few studies to improve the outcome in these eyes. [ 6 7 8 9 10 11 ] These studies have studied the effect of posterior laser in a limited number of eyes and have used varying criteria for treatment. Data about this underutilized technique in a larger cohort of eyes are lacking.…”

Role of additional posterior barrage laser in type 1 zone 2 retinopathy of prematurity: A randomized trial

“…The efficacy of laser treatment to the ridge or vascular retina posterior to the ridge in advanced stage 3 or early stage 4 disease has been reported previously. [ 3 4 5 6 ] It has also been noted that the eyes receiving barrage laser tend to regress faster with minimal residual disease [ Table 1 ]. [ 3 4 5 ] Various mechanisms have been proposed to support the role of barrage laser.…”

“…[ 3 4 5 6 ] It has also been noted that the eyes receiving barrage laser tend to regress faster with minimal residual disease [ Table 1 ]. [ 3 4 5 ] Various mechanisms have been proposed to support the role of barrage laser. [ 3 ] First, the laser burn acts as a mechanical barrier to retinal detachment by creating chorioretinal adhesions.…”

“…Additional laser barrage posterior to the ridge was introduced for advancing stage 3+ disease and early stage 4A disease to prevent posterior advancement of the tractional retinal detachment. [ 3 4 5 ] This approach was found to be beneficial and created chorioretinal adhesions that would prevent constant traction emanating from the vascular ridge from detaching the retina further posteriorly. Barrage laser not only led to regression in an additional subset of patients but also had faster regression with minimal residual changes such as disc macular drag and preretinal hemorrhage.…”