Bedside Diode Laser Photocoagulation Under Remifentanil Analgesia for Retinopathy of Prematurity: Early Structural Outcomes

Objectives: To evaluate one-year structural outcomes of bedside diode laser photocoagulation with remifentanil analgesia for retinopathy of prematurity (ROP) and discuss clinical and demographic characteristics of infants and other possible risk factors that may affect the outcome. Materials and Methods: The medical records of premature infants who were treated with bedside transpupillary diode laser photocoagulation under remifentanil analgesia for ROP were evaluated for clinical and demographic characteristics, accompanying systemic risk factors, laser parameters, complications of treatment, retreatment rate and one-year structural outcomes. Results: One-hundred and ninety-five eyes of 99 infants (59 males, 40 females) were recruited for the study. The mean gestational age and birth weight were 27.4 +/- 2.3 weeks (23-34) and 1003.3 +/- 297.8 g (570-2250), respectively. Laser therapy was performed for high-risk prethreshold ROP in 66.2% of eyes, aggressive posterior ROP (APROP) in 15.4% and threshold ROP in 18.4%. The mean number of laser spots was 1510.4 +/- 842.1 per laser session. No adverse effects of laser photocoagulation were observed except small lens opacities in two eyes and corneal opacity in one eye. Retreatment was needed in only three eyes, and vitreoretinal surgery was needed in six eyes of six patients despite laser treatment. Anatomic outcome was favorable in 189 eyes (96.9%) at the end of a 1-year follow-up. Presence of dilated and tortuous iris vessels (p= 0.002) and tunica vasculosa lentis (p= 0.009) along with type of ROP (APROP and stage 4a ROP at initial presentation) (p= 0.001) were associated with poor anatomical outcome. Conclusion: Accurate and timely bedside transpupillary diode-laser photocoagulation under remifentanil analgesia is an effective and safe treatment modality for ROP, and may prevent vision-threatening retinal detachment and reduce the need for vitreoretinal surgery.