Objective: 

To compare the refractive outcomes of laser-treated and non-laser-treated retinopathy of prematurity (ROP) infant, at 2 years of age in Hospital Selayang.

Methods:

Retrospective review involving patients born between 2016 and 2018. They were divided into those who were treated with laser photocoagulation, and those who were observed. Laser treatment was given to infants with threshold and high-risk, pre-threshold disease. Refractive error was identified by cycloplegic refraction at 2 years of age.

Results: 

There were 22 eyes from 11 infants in the laser-treated group, all of which had zone II ROP with plus disease; of these, four had stage 2 ROP and 18 had stage 3 ROP. There were 53 eyes from 28 patients in the non-laser-treated group. The mean birth weight for the laser-treated and non-laser-treated groups was 966.9 ± 92.6 g and 1019.3 ± 282.0 g, respectively (P = 0.398). Mean gestational age for the laser-treated and non-laser-treated groups was 28.2 ± 2.2 weeks and 27.7 ± 2.2 weeks, respectively (P = 0.390). At 2 years, the mean spherical equivalence for the laser-treated and non-laser treated groups was -0.55 ± 2.49 D and +0.17 ± 1.43 D, respectively, although the difference was not statistically significant (P = 0.120). Myopia was commoner in the laser-treated group (six eyes [27%] vs five eyes [9%], P = 0.047), and two eyes from two different infants (10%) from this group also developed high myopia (> -6.00 D). For hypermetropia and astigmatism, there were no statistically significant differences between the groups (all P > 0.05). High myopia was strongly related to the post-conceptual age when receiving laser therapy (P = 0.025). In the laser-treated group, two infants (9%) had amblyopia and one (5%) had exotropia at 2 years of age. None of the eyes developed structural retinal sequelae.

Conclusion:

Despite successful treatment of ROP, a significant number of laser-treated eyes developed myopia. This highlights the need for long-term refractive screening in these patients.

1. Hellström, A., Smith, L. E. H., & Dammann, O. (2013). Retinopathy of prematurity. The Lancet, 382(9902), 1445–1457. https://doi.org/10.1016/S0140-6736(13)60178-6
2. Malaysian National Neonatal Registry, & Clinical Research Centre, Ministry of Health Malaysia. (2017). Annual report 2017. http://www.acrm.org.my/mnnr
3. O’Connor, A. R., Stephenson, T., Johnson, A., Tobin, M. J., Moseley, M. J., Ratib, S., & Fielder, A. R. (2002). Long-term ophthalmic outcome of LBW children with and without ROP. Pediatrics, 109(1), 12–18. https://doi.org/10.1542/peds.109.1.12
4. Quinn, G. E., Dobson, V., Davitt, B. V., Hardy, R. J., Tung, B., Pedroza, C., Good, W. V., & Early Treatment for Retinopathy of Prematurity Cooperative Group. (2013). Progression of myopia and high myopia in the Early Treatment for Retinopathy of Prematurity study: Findings at 4 to 6 years of age. Journal of AAPOS, 17(2), 124–128. https://doi.org/10.1016/j.jaapos.2012.10.021
5. Yang, C. S., Wang, A. G., Shih, Y. F., & Hsu, W. M. (2013). Long-term biometric optic components of diode laser-treated threshold retinopathy of prematurity at 9 years of age. Acta Ophthalmologica, 91(4), 276–282. https://doi.org/10.1111/j.1755-3768.2011.02353.x
6. Yang, C. S., Wang, A. G., Sung, C. S., Hsu, W. M., Lee, F. L., & Lee, S. M. (2010). Long-term visual outcomes of laser-treated threshold retinopathy of prematurity: A study of refractive status at 7 years. Eye, 24(1), 14–20. https://doi.org/10.1038/eye.2009.61
7. Cryotherapy for Retinopathy of Prematurity Cooperative Group. (2001). Multicenter trial of cryotherapy for retinopathy of prematurity: Ophthalmological outcome at 10 years. Archives of Ophthalmology, 119(8), 1110–1118. https://doi.org/10.1001/archopht.119.8.1110
8. Ritch, R., Chang, B. M., & Liebmann, J. M. (2003). Angle closure in younger patients. Ophthalmology, 110(10), 1880–1889. https://doi.org/10.1016/S0161-6420(03)00563-3
9. Chiang, M. F., Quinn, G. E., Fielder, A. R., Ostmo, S., Paul Chan, R. V., Berrocal, A., Capone, A., Jr., Campbell, J. P., Cernichiaro-Espinosa, L. A., Eisner, G., Good, W. V., Hartnett, M. E., Holmstrom, G., Kusaka, S., Kychenthal, A., Lepore, D., Lorenz, B., Martinez-Castellanos, M. A., Mintz-Hittner, H. A., ... International Committee for the Classification of Retinopathy of Prematurity. (2021). International Classification of Retinopathy of Prematurity, 3rd edition. Ophthalmology, 128(10), 1479–1487. https://doi.org/10.1016/j.ophtha.2021.05.031
10. Ministry of Health Malaysia, & Academy of Medicine Malaysia. (2005). Clinical practice guidelines: Retinopathy of prematurity. Ministry of Health Malaysia.
11. Early Treatment for Retinopathy of Prematurity Cooperative Group. (2003). Revised indications for the treatment of retinopathy of prematurity: Results of the Early Treatment for Retinopathy of Prematurity randomized trial. Archives of Ophthalmology, 121(12), 1684–1694. https://doi.org/10.1001/archopht.121.12.1684
12. Reynolds, J. D., & Dobson, V. (2002). Evidence-based screening criteria for retinopathy of prematurity: Natural history data from the CRYO-ROP and LIGHT-ROP studies. Archives of Ophthalmology, 120(11), 1470–1476. https://doi.org/10.1001/archopht.120.11.1470
13. Flitcroft, D. I., He, M., Jonas, J. B., Jong, M., Naidoo, K., Ohno-Matsui, K., Rahi, J., Resnikoff, S., Vitale, S., & Wolffsohn, J. S. (2019). IMI – Defining and classifying myopia: A proposed set of standards for clinical and epidemiologic studies. Investigative Ophthalmology & Visual Science, 60(3), M20–M30. https://doi.org/10.1167/iovs.18-25957
14. Nguyen, P. H., Catt, C., Nguyen, T. X., & Pham, V. T. (2015). Refractive outcome of prethreshold retinopathy of prematurity treated by diode laser: Follow-up at 5 years. Clinical Ophthalmology, 9, 1753–1758. https://doi.org/10.2147/OPTH.S88062
15. Vinekar, A., Dogra, M. R., Sangtam, T., Narang, A., & Gupta, A. (2007). Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: Ten year data from a tertiary care center in a developing country. Indian Journal of Ophthalmology, 55(5), 331–336. https://doi.org/10.4103/0301-4738.33847
16. Al-Otaibi, A. G., Aldrees, S. S., & Mousa, A. A. (2012). Long term visual outcomes in laser treated threshold retinopathy of prematurity in Central Saudi Arabia. Saudi Journal of Ophthalmology, 26(3), 299–303. https://doi.org/10.1016/j.sjopt.2012.05.006
17. Lee, G. A., Hilford, D. J., & Gole, G. A. (2004). Diode laser treatment of pre-threshold and threshold retinopathy of prematurity. Clinical & Experimental Ophthalmology, 32(2), 164–169. https://doi.org/10.1111/j.1442-9071.2004.00795.x
18. Early Treatment for Retinopathy of Prematurity Cooperative Group. (2004). Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Transactions of the American Ophthalmological Society, 102, 233–250.
19. Katoch, D., Sanghi, G., Dogra, M. R., Beke, N., & Gupta, A. (2011). Structural sequelae and refractive outcome 1 year after laser treatment for type 1 prethreshold retinopathy of prematurity in Asian Indian eyes. Indian Journal of Ophthalmology, 59(6), 423–426. https://doi.org/10.4103/0301-4738.86307
20. Yang, C. S., Wang, A. G., Shih, Y. F., & Hsu, W. M. (2013). Astigmatism and biometric optic components of diode laser-treated threshold retinopathy of prematurity at 9 years of age. Eye, 27(3), 374–381. https://doi.org/10.1038/eye.2012.274
21. Cook, A., White, S., Batterbury, M., & Clark, D. (2008). Ocular growth and refractive error development in premature infants with or without retinopathy of prematurity. Investigative Ophthalmology & Visual Science, 49(12), 5199–5207. https://doi.org/10.1167/iovs.07-1605
22. Sahni, J., Subhedar, N. V., & Clark, D. (2005). Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: A study of motility, refractive, and anatomical outcomes at 6 months and 36 months. British Journal of Ophthalmology, 89(2), 154–159. https://doi.org/10.1136/bjo.2004.047811
23. Fledelius, H. C. (1995). Myopia of prematurity, clinical patterns: A follow-up of Danish children now aged 3-9 years. Acta Ophthalmologica, 73(5), 402–406. https://doi.org/10.1111/j.1755-3768.1995.tb05309.x
24. Early Treatment for Retinopathy of Prematurity Cooperative Group. (2008). Prevalence of myopia and high myopia in the Early Treatment for Retinopathy of Prematurity study. Ophthalmology, 115(6), 1058–1064. https://doi.org/10.1016/j.ophtha.2007.08.019
25. Lok, J. Y. C., Yip, W. W. K., Luk, A. S. W., Chin, J. K. Y., Lau, H. H. W., & Young, A. L. (2018). Visual outcome and refractive status in first 3 years of age in preterm infants suffered from laser-treated Type 1 retinopathy of prematurity (ROP): A 6-year retrospective review in a tertiary centre in Hong Kong. International Ophthalmology, 38(1), 163–169. https://doi.org/10.1007/s10792-017-0453-y
26. Pan American Health Organization. (2019). Clinical practice guidelines for the management of retinopathy of prematurity: Summarized version 2017. PAHO. https://doi.org/10.37757/MR2019.V21.N4.9
27. Mintz-Hittner, H. A., Kennedy, K. A., & Chuang, A. Z. (2011). Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. New England Journal of Medicine, 364(7), 603–615. https://doi.org/10.1056/NEJMoa1007467
28. Stahl, A., Lepore, D., Fielder, A., Fleck, B., Rufibach, K., Schild, G., & RAINBOW Study Group. (2019). Ranibizumab versus laser therapy for the treatment of very low birth weight infants with retinopathy of prematurity (RAINBOW): An open-label randomised controlled trial. The Lancet, 394(10208), 1551–1559. https://doi.org/10.1016/S0140-6736(19)31344-3
29. Gelonek, M. M., Chuang, A. Z., Clark, W. L., Gee, S. S., Wheaton, D. H., Do, B. L., Mintz-Hittner, H. A., & BEAT-ROP Cooperative Group. (2014). Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment. JAMA Ophthalmology, 132(11), 1327–1333. https://doi.org/10.1001/jamaophthalmol.2014.2882
30. Axer-Siegel, R., Maharshak, I., Snir, M., Friling, R., Weinberger, D., & Sirota, L. (2008). Diode laser treatment of retinopathy of prematurity: Anatomical and refractive outcomes. Retina, 28(6), 839–846. https://doi.org/10.1097/IAE.0b013e3181657fc6
31. Ruan, L., Shan, H. D., Liu, H. Z., & Huang, X. (2015). Refractive status of Chinese with laser-treated retinopathy of prematurity. Optometry and Vision Science, 92(1), 3–9. https://doi.org/10.1097/OPX.0000000000000445