Hunter D G, Repka M X
Wilmer Ophthalmologic Institute, Johns Hopkins University, Baltimore, MD 21287-9009.
Ophthalmology. 1993 Feb;100(2):238-44. doi: 10.1016/s0161-6420(93)31664-7.
Although peripheral cryotherapy decreases the incidence of unfavorable anatomic outcomes in threshold retinopathy of prematurity (ROP), apnea, bradycardia, and lid edema can occur. Argon laser indirect ophthalmoscope photocoagulation has been used as an alternative to cryotherapy, with fewer adverse effects. Retinal lesions placed with diode lasers are deeper than similar argon laser lesions, and it is not known whether this difference could influence the response to ablative therapy.
Patients were enrolled under a prospective, randomized protocol. One eye of each patient with symmetric, threshold ROP was treated with an 814/815 nm diode laser, while the other eye was treated with cryotherapy. Patients with asymmetric diseases also were randomized for treatment in the threshold eye.
Nineteen infants (33 eyes) were treated, ranging from 485 to 863 g birth weight (23 to 27 weeks gestational age); 18 patients (32 eyes) were followed for 3 months or longer. Four patients (8 eyes) had bilateral zone 1 disease. Postconceptional age was 36 to 45 weeks at the time of treatment. The diode laser treatment was better tolerated than cryotherapy, and the treatment apparatus was more easily transported. Apneic episodes requiring intubation resulted from two cryotherapy sessions but no diode laser sessions. Five cryotherapy-treated eyes required retreatment because of persistent disease with adjacent skip areas. In the group followed for 3 to 15 months, 1 cryotherapy-treated eye and 1 diode laser-treated eye progressed to stage 5 retinal detachment.
Compared with cryotherapy, the diode laser was more convenient, technically easier to administer, and better tolerated by the patient. Although the number of patients was too small for meaningful statistical analysis of outcome, diode laser peripheral retinal ablation appeared to be as effective as cryotherapy for the treatment of threshold ROP.
尽管周边冷冻疗法可降低阈值型早产儿视网膜病变（ROP）不良解剖学结局的发生率，但可能会出现呼吸暂停、心动过缓和眼睑水肿。氩激光间接检眼镜光凝术已被用作冷冻疗法的替代方法，且不良反应较少。二极管激光造成的视网膜病变比类似的氩激光病变更深，尚不清楚这种差异是否会影响消融治疗的效果。
患者按照前瞻性随机方案入组。每位患有对称性阈值型ROP的患者的一只眼睛接受814/815 nm二极管激光治疗，而另一只眼睛接受冷冻疗法治疗。患有不对称疾病的患者也被随机分配对阈值眼进行治疗。
治疗了19名婴儿（33只眼），出生体重485至863 g（胎龄23至27周）；18名患者（32只眼）随访了3个月或更长时间。4名患者（8只眼）患有双侧1区疾病。治疗时的孕龄为36至45周。二极管激光治疗的耐受性优于冷冻疗法，且治疗设备更易于运输。两次冷冻疗法治疗导致需要插管的呼吸暂停发作，但二极管激光治疗未出现。5只接受冷冻疗法治疗的眼睛因疾病持续伴有相邻跳跃区而需要再次治疗。在随访3至15个月的组中，1只接受冷冻疗法治疗的眼睛和1只接受二极管激光治疗的眼睛进展为5期视网膜脱离。
与冷冻疗法相比，二极管激光更方便，技术上更易于实施，且患者耐受性更好。尽管患者数量过少，无法对结局进行有意义的统计分析，但二极管激光周边视网膜消融术在治疗阈值型ROP方面似乎与冷冻疗法一样有效。
