Comparing the outcome of single vs multiple session laser photocoagulation in Zone 1 APROP in Asian Indian eyes – a prospective, single-centre, randomized, interventional study

Anand Vinekar
Sherine Braganza
Bhujang Shetty

Department of Pediatric Retina, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India

Purpose: To compare two laser techniques to ablate flat neovascularization (FNV) in cases with Aggressive Posterior Retinopathy of Prematurity (APROP).

Methods: Sixty consecutive eyes (30 infants) with Zone 1 APROP requiring laser treatment were selected to receive laser by one of the two laser options (one option per eye -Group A or B) previously suggested by the PHOTO-ROP group. Group A underwent single session laser photocoagulation of the avascular retina underlying the FNV by direct laser over the fronds. Group B eyes were lasered in 2 sessions where the avascular retina underlying the FNV was lasered after 7 days when the neovascular fronds had retracted, exposing the avascular strip. Outcome following laser and complications between the two groups were analyzed.

Results: Group A eyes had higher incidence of hemorrhages, (12/30 vs 5/30), greater number of hemorrhages (mean 9 vs 3) and larger hemorrhages (10% vs 0% of 3 disc diameters or larger hemorrhage) compared to Group B eyes. (p < 0.05). Three eyes (10%) in Group A and none in group B developed local fibrosis (< 1- 2 clock hours) over the treated FNV. All eyes (100%) of group B and 90% (27/30) of group A showed favorable outcome following laser. The median follow-up was 12 months.

Conclusion: This is the first study to compare the two methods of laser for FNV in APROP suggested by the PHOTO-ROP group. The results demonstrate the advantages of the multi-session method, which results in lesser hemorrhage, faster resolution and regression without fibrotic contraction.