Role of LASERS in stage 4A retinopathy of prematurity (ROP)
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ORIGINAL ARTICLE
Role of LASERS in stage 4A retinopathy of prematurity (ROP) Shilpi H. Narnaware 1
&
Prashant K. Bawankule 1
Received: 29 June 2020 / Accepted: 10 August 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract To study the anatomical success rate of light amplification by stimulated emission of radiation (LASERS) as first line of management in stage 4A retinopathy of prematurity (ROP). Observational, prospective case series of 14 eyes of 7 babies (males: 3, females: 4) with stage 4A ROP who underwent LASERS for stage 4A between January 2018 and July 2019. Gestation age (GA), birth weight (BW), and post-menstrual age (PMA) at which laser was done were noted in all cases. A number of clock hours of detachment at the time of presentation were noted in all babies. All babies were followed up up to 6 months after laser for any recurrence. Success was defined as complete regression of disease without the need of any other modality of treatment like anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. A total of 92.85% (13/14) showed complete regression of disease. One eye progressed to stage 4B ROP warranting lenssparing vitrectomy (LSV). LASERS is an effective method of management without any need of anti-VEGF or surgical intervention even in babies with stage 4A ROP. Keywords Stage 4A ROP . LASERS . Lens-sparing vitrectomy . Anatomical success
Introduction Retinopathy of prematurity (ROP) is a vaso-proliferative disorder of premature and low birth babies. If untreated, it can lead to retinal detachment secondary to neovascularization and causes visual loss. Severity of ROP is defined by stages of ROP. There are 5 stages of ROP (Fig. 1): stage 1: demarcation line; stage 2: ridge with height and width; stage 3: extraretinal fibrovascular proliferation; stage 4A: extrafoveal retinal detachment; stage 4B: subtotal retinal detachment involving the fovea; stage 5: total retinal detachment. Extent of ROP is defined as the circumference of vascularized retina and is described by 30° sectors or clock hours (Fig. 2). Location of disease is described by its zone (Fig. 2). Zone I is posterior pole, and its border is strictly defined as a circle with optic nerve in its center and with a radius twice the
* Shilpi H. Narnaware [email protected] Prashant K. Bawankule [email protected] 1
Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur, Maharashtra 440025, India
distance from the center of the optic nerve to the center of the macula. Zone II extends from the edge of zone I to a circle with radius equal to the distance from the optic nerve to the nasal ora serrata. Zone III is the residual crescent anterior to zone II. Pre-plus disease (Fig. 3a) is defined as vascular abnormalities of posterior pole that are insufficient for diagnosis of plus disease, but that demonstrate more arterial tortuosity and more venous dilatation than normal. Plus disease (Fig. 3b) is defined as marked vascular dilation and tortuosity of posterior pole vessels in at least 2 q
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