Title: Surgical Management of Retinopathy of Prematurity
Abstract: Untreated threshold retinopathy of prematurity leads to retinal detachment in over 40% of cases (Cryotherapy for Retinopathy of Prematurity Cooperative Group 1988, 1994). Peripheral retinal ablation is effective in preventing the progression to retinal detachment in the majority of eyes with ROP (Cryotherapy for Retinopathy of Prematurity Cooperative Group 1988, 1994; Good and Early Treatment for Retinopathy of Prematurity Cooperative Group 2004; Early Treatment for Retinopathy of Prematurity Cooperative Group 2003). In the Early Treatment for Retinopathy of Prematurity (ETROP) trial 9.1% of laser-treated eyes progressed to retinal detachment, however, the trial used a pattern of laser burns up to one spot diameter apart (Good and Early Treatment for Retinopathy of Prematurity Cooperative Group 2004; Early Treatment for Retinopathy of Prematurity Cooperative Group 2003). Studies using a denser, near-confluent, laser pattern have generally reported lower progression rates of 3–4% (Banach et al. 2000; Rezai et al. 2005). Conversely, detachments after laser treatment are more often seen in eyes with incomplete peripheral ablation, and in those with Aggressive Posterior ROP (APROP) in zone I or posterior zone II (Drenser et al. 2010; Gunn et al. 2014). Almost all eyes that progress after photoablation do so within 9 weeks of treatment and this well-described and predictable pattern facilitates early diagnosis and intervention.