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Study: Factors other than just laser may contribute to ischemia in infants with ROP
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KOLOA, Hawaii — A study that examined the incidence of ischemia in infants with ROP following laser photoablation found that the laser treatment was not the only contributing factor for its development.
At the Retina 2007 meeting, held in conjunction with Hawaiian Eye 2007, Nina Berrocal, MD, presented results from a retrospective review of 1,440 premature infants with ROP treated between January 1, 2006, and June 1, 2006.
Confluent, dense laser therapy does not induce ischemia. All infants who developed ischemia were treated with intermittent dense laser patterns with a diode laser.
Dr. Berrocal said 10 eyes of seven patients developed signs of anterior segment ischemia secondary to laser photoablation with diode laser. No patients showed evidence of inadvertent treatment of anterior structures or retinal detachment.
Although studies by Kaiser and colleagues, and Lambert and colleagues, suggested that ischemia is caused by confluent laser treatment, Dr. Berrocal said, "I don't use intermittent laser and I have never had a case of ischemia."
Dr. Berrocal said there were other contributing factors to the development of ischemia. For instance, she said, "anterior segment ischemia primarily affects premature infants with low birth weights." She said the mean birth weight of patients developing anterior segment ischemia was 855 g with a range of 620 g to 1,075 g.
"The mean gestational age of patients developing anterior segment ischemia after laser therapy was 26.1 weeks with a range of 24 to 28 weeks," she said. "Patients developed cataracts approximately 4.5 weeks after laser treatment."
"Excluding referrals, only three eyes in two patients developed signs of anterior segment ischemia secondary to laser photoablation."
Additionally, out of seven referrals, Dr. Berrocal found experienced surgeons treated four eyes, and inexperienced surgeons (those with less than 1 year of experience) treated three eyes. Of the three eyes to develop ischemia in her clinic, fellows treated all. Other reasons for anterior segment ischemia are direct laser-induced injury to immature long posterior ciliary vessels, subclinical damage to anterior segment structures, scleral depression-induced ischemia and VEGF decline following laser therapy causing anterior segment or ciliary vasculature dysgenesis.