Posterior to the ridge laser treatment for severe stage 3 retinopathy of prematurity

Background Current methods of treating the avascular retina with laser photocoagulation for severe retinopathy of prematurity (ROP) are not completely effective in the reduction of visual morbidity. We report a case series in which additional laser treatment, called ‘posterior laser’, was delivered posterior to the neovascular ridge, for eyes with severe stage 3 ROP in zone II with avascular retina posterior to the ridge. Design Retrospective chart review. Participants Infants who underwent laser treatment, posterior to the neovascular ridge for severe ROP at the Alberta Children’s Hospital, between January 2005 and October 2008. Methods Charts were reviewed for 18 eyes of 11 patients and collected information included demographic data, clinical examination results, and digital retinal images. Main Outcome Measures Structural and functional outcomes of treatment. Results Four (22%) of 18 eyes received ‘posterior laser’ as primary treatment and the remainder of eyes (78%) received ‘posterior laser’ following previous laser photocoagulation anterior to the neovascular ridge. Mean birthweight was 688 g (552–930) and mean gestational age was 24 weeks (23–28). There were no complications because of the posterior laser treatment. In all, 16 of 18 eyes experienced rapid regression of the ridge and subsequent decrease in vascular dilation and tortuosity within 1 week. Two eyes required vitrectomy for 4A retinal detachment; however, no eyes developed stage 4B ROP. Conclusion Posterior to the ridge laser in the setting of the morphological criteria described had no increased safety concerns and resulted in rapid regression of ROP with good outcomes.