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ABSTRACT: To describe a new modified technique in the treatment of ROP (retinopathy of prematurity) using the RetCam 3 digital imaging system - Camera-Assisted Laser photocoagulation and Cryotherapy of the Retina (CALCR).
From Nov 2011 to Oct 2013, 113 infants were diagnosed with ROP. The average post-conceptual age (PCA) at the time of diagnosis was the 35(th) week of PCA; the average birth weight was 1,041 g. According to the ETROP study, the avascular part of the retina of infants with high-risk prethreshold ROP was treated with a trans-scleral diode laser or with cryotherapy within 48-72 h after the diagnosis. The intervention was performed under general anaesthesia under the direct visual control of the RetCam 3.
The CALCR technique was used in all 23 infants (46 eyes) diagnosed with high-risk prethreshold ROP. The average age of these infants at the time of the intervention was the 38(th) week of PCA. None of the infants had any serious complications during the CALCR procedure. In contrast to the traditional technique, CALCR offers many benefits: the image of the retina is real, magnified and not inverted, it shows details of the retina in a high resolution, photo and video documentation is available. Therefore the preoperative, intraoperative and postoperative condition of the retina can be precisely evaluated and compared on a fully standardized basis.
The CALCR procedure represents a new technique providing greater accuracy when targeting the avascular part of the retina, enables better visualisation and more precise treatment, and reduces the risk of unintended damage to healthy retinal tissue.
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 07/2015; DOI:10.5507/bp.2015.027 · 1.20 Impact Factor
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To investigate efficacy of intravitreal injection of pegaptanib and laser photocoagulation for treatment of stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels, and final structural outcome with conventional laser photocoagulation or combined with cryotherapy.
In a prospective comparative study, 152 eyes with zone I, II posterior ROP 3+ (76 premature rabies), from 2009 to 2011, were included. Patients were randomly assigned to receive intravitreal pegaptanib (Macugen® 0.3 mg = 0.02 mL, Pfizer) with conventional diode laser photocoagulation in group 1 (68 eyes of 34 infants) or only laser therapy combined with cryotherapy in group 2 (84 eyes of 42 infants), bilaterally. The primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP. The mean follow-up after treatment was 19.3 months in group 1 and 21.5 months in group 2.
Final favorable anatomic outcome and stable regression of ROP at last control examination was noted in 89.7% of eyes in group 1 and 60.8 % of eyes in group 2. Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in group 1. No recurrence of neovascularization (stage 3+ ROP) was identified in 85.4% of patients in group 1 and 50% of patients in group 2.
Results of this study support the administration of intravitreal pegaptanib as useful therapy in the management of stage 3+ ROP.
European journal of ophthalmology 06/2012; 22(5):687-94. DOI:10.5301/ejo.5000166 · 1.07 Impact Factor
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ABSTRACT: To evaluate efficacy and safety of intravitreal injection of pegaptanib or bevacizumab and laser photocoagulation for treatment of threshold stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels with conventional laser photocoagulation or combined with cryotherapy.
In this prospective comparative study, 174 eyes of 87 premature babies, from January 2008 to December 2011, were included. All infants were diagnosed with stage 3+ ROP for zone I or posterior II. Patients were randomly assigned to receive intravitreal pegaptanib (0.3 mg) or bevacizumab (0.625 mg/0.025 ml of solution) with conventional diode laser photocoagulation (Group A, 92 eyes of 46 infants) or laser therapy combined with cryotherapy (Group 8, 82 eyes of 41 infants), bilaterally. The main evaluated outcomes include time of regression and decrease of plus signs and development of peripheral retinal vessels after treatment, final structural-anatomic outcomes compared in the both groups of patients. Risk factors and other characteristics of infants include birth weight, gestational age, Apgar score, duration of intubation and hospitalizations, postmenstrual age at treatment, sepsis, surgery for necrotizing enterocolitis, intraventricular hemorrhage. Primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP in one or both eyes (reccurrence rate = 0) by 55 weeks' postmenstrual age. Treatment failure was defined as the recurrence of neovascularization (reccurrence rate = 1 or 2) in one or both eyes requiring retreatment. The mean follow-up after treatment was 23.5 months (range 4 - 45 months) in the Group A, and 25.2 months in the Group B (range 3 - 48 months).
Final favorable anatomic outcome and stable regression of ROP at last control examination have 90.2% of eyes after adjuvant intavitral pagaptanbib or bevacizumab in the Group A, and 62% of eyes after only conventional treatment in the Group B (P = 0.0214). Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in Group A patients who received intravitreal VEGF inhibitors and laser. An absence of recurrence of neovascularization (stage 3+ ROP) was identified at 87% of patients in the Group A, and 53% of patients in the Group B. This difference between the both groups was statistically significant (P = 0.0183). ROP reccured in 7 from 92 eyes (7.6%) in the Group A, and 23 from 82 eyes (28%) in the group B (P = 0.0276). Significantly better treatment effect was found for adjuvant intravitreal pagaptanib or bevacizumab with laser compared with conventional therapy of ROP 3+ in zone I and posterior zone II. Perioperative retinal haemorrhages after laser photocoagulation occured in 8% of eyes in the Group A, and 11% of eyes in the group B (P = 0.358), in all eyes with spontaneous resorption. No systemic or significant ocular complications of intravitreal anti-VEGF injections, such as endophthalmitis or retinal detachment were found during follow-up period after operation.
A combination of intravitreal pegaptanib or bevacizumab injection and laser photocoagulation showed to be a safe, well tolerated and effective therapy in patients with stage 3+ ROP in zone I and posterior zone II. Adjuvant intravitreal antiVEGF injection, as compared with conventional laser or cryotherapy, showed significant benefit in terms of better final anatomic outcome, induction of prompt regression, rapid development of peripheral retinal vascularization and decrease of recurrence rate of neovascularization. Results of this study support the administration of pegaptanib and bevacizumab as an alternative usefull therapy in the management of stage 3+ ROP.
Ceská a slovenská oftalmologie: casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti 02/2012; 68(1):29-36.
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ABSTRACT: To evaluate the effectiveness and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy.
Retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9 5.3 years (range: 4months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, and the absence of visually threatening complications, no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1 6.5 years (range: 1.6 to 15.2 years).
Mean preoperative and postoperative IOP was 33.6 11.4 mmHg and 17.1 6.5 mmHg (p 0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years and 65% at six years. There was no difference between primary (n = 31 eyes) and secondary glaucoma (n = 45 eyes) patients in terms of cumulative success (p = 0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed with these causes: 10 eyes with uncontrolled IOP, 2 eyes of retinal detachment and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure.
Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractive to the initial surgical procedure and medical therapy.
Ceská a slovenská oftalmologie: casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti 06/2009; 65(3):79-86.