Factors related to poor visual outcome in patients with retinopathy of prematurity after xenon arc photocoagulation and/or cryocautery

We evaluated long-term visual outcome following xenon arc photocoagulation and/or cryocautery in 28 patients (52 eyes) with retinopathy of prematurity. Outcomes were divided into two groups: 43 eyes had visual acuity of 0.6 or better, 9 eyes had visual acuity of 0.2 or worse. Poor visual outcomes resulted primarily from macular degeneration. Risk factors involved were low birthweight (Mann-Whitney's U test, P = 0.03); the presence of signs of possible rapid progression ( χ 2 test, P = 0.041); treatment of more clock hours of the fundus (Mann-Whitney's U test; P = 0.035) as well as the inside of the vascular arcade ( χ 2 test P = 0.0034); and total (360°) cryocautery ( χ 2 test, P = 0.032). Macular degeneration occurred either as an isolated small focus extending circumferentially around the fovea or as a result of extension from the temporal degeneration caused by treatment. This suggests that intensive treatment, in addition to prematurity and the severity of retinopathy, is involved in the development of macular degeneration. Overtreatment should be carefully avoided in zone I retinopathy of prematurity and zone II retinopathy with signs of possible rapid progression, which requires photocoagulation inside the vascular arcade.