Combined treatment with laser photocoagulation and cryotherapy for threshold retinopathy of prematurity

PURPOSE. To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP). METHODS. Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. RESULTS. A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over -6 diopters. CONCLUSIONS. Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.