External subretinal drainage, bevacizumab, and scleral buckling for complete exudative retinal detachment after photocoagulation in retinopathy of prematurity

INCIDENCE AND RISK FACTORS FOR EXUDATIVE RETINAL DETACHMENT FOLLOWING LASER PHOTOCOAGULATION FOR RETINOPATHY OF PREMATURITY

PURPOSE

Exudative retinal detachment (ERD) may result from laser photocoagulation for retinopathy of prematurity. Although risk factors have been hypothesized from case reports, comparative studies have not been reported. We sought to evaluate risk factors for ERD following laser, comparing affected and unaffected infants.

METHODS

Retrospective cohort study of infants undergoing retinopathy of prematurity laser at the Children's Hospital of Philadelphia over 6 years. All received near-confluent laser of avascular retina. Demographic, medical, and procedural risk factors for ERD were evaluated in univariate analysis because of the rarity of ERD.

RESULTS

Among 149 lasered infants, 6 infants (4%, 95% confidence interval [CI] 1.5%-8.6%) developed ERD. Race was a significant risk factor ( P = 0.01). Among 71 African American or Hispanic infants, 6 (8.5%, 95% CI 3.2%-17.5%) developed ERD. Among 78 non-African American or Hispanic infants, 0 (0%, 95% CI 0%-4.6%) developed ERD. There were no significant differences in the other studied factors.

CONCLUSION

Exudative retinal detachment was uncommon (4%) following retinopathy of prematurity laser. Despite so few cases, darker pigmented race with likely increased pigmented fundi was significantly associated with an increased ERD risk. Further study may reveal whether increased choroidal pigment causes greater laser tissue damage or makes it difficult to discern the ora, resulting in inadvertent lasering of the ciliary body, leading to ERD.

Atypical Late-Onset Exudative Retinal Detachment in a Treatment-Naïve Infant With Retinopathy of Prematurity

A male infant born at 23 weeks gestation with a birthweight of 660 grams presented with retinopathy of prematurity (ROP) that began progressing at 44 weeks. He subsequently developed Zone III, Stage 3, pre-plus disease in both eyes (OU), as well as scattered exudates in the macula, dragged vessels temporally, and an exudative retinal detachment temporally in the left eye after a period of regressing and stable ROP. After bilateral laser photocoagulation, there was regression of the neovascularization, resolution of the exudative detachment, and eventual stabilization of disease OU by 12 months postmenstrual age. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:403-406.].

EXUDATIVE RETINAL DETACHMENT DOCUMENTED BY HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AFTER RETINAL LASER PHOTOCOAGULATION FOR RETINOPATHY OF PREMATURITY

BACKGROUND

Few cases of exudative retinal detachments have been reported in the literature after laser treatment for retinopathy of prematurity, and none of the cases include optical coherence tomography images.

METHODS

Case report.

RESULTS

A 469-g birth weight, 25-week gestational age baby girl at 35-week postmenstrual age received a retinal laser (1,724 spots in the right eye and 1,287 spots in the left eye) for bilateral Stage 3 Zone II plus disease retinopathy of prematurity. The patient developed a large macular exudative retinal detachment seen in the right eye at the first follow-up, 5 days after the laser. Serial handheld optical coherence tomography demonstrated resolution of retinal detachment and intraretinal fluid over the course of 4 weeks with only topical tobramycin/dexamethasone ophthalmic ointment 3 to 4 times daily for 2 weeks. The patient was left with a residual subretinal scar and outer retinal loss on optical coherence tomography, with a later appearance of a dragged macula on funduscopic examination noted at 52-week postmenstrual age. It is unclear whether systemic steroid therapy, intravitreal bevacizumab, or surgery would hasten resolution of exudative retinal detachment after the retinopathy of prematurity laser and avoid photoreceptor damage seen on optical coherence tomography in this case.

CONCLUSION

This case suggests that post-retinopathy of prematurity laser exudative retinal detachments can resolve without aggressive intervention, but may cause permanent retinal sequelae.

Macular Sequelae Following Exudative Retinal Detachment After Laser Photocoagulation for Retinopathy of Prematurity

BACKGROUND AND OBJECTIVE

To report a series of exudative retinal detachments (ERDs) following laser photocoagulation for retinopathy of prematurity (ROP).

PATIENTS AND METHODS

Retrospective case series.

RESULTS

Eleven eyes of seven infants were identified who developed ERD following laser. Median gestation age was 25 weeks (interquartile range [IQR]: 24-27 weeks), and median birth weight was 662 grams (IQR: 538-850 grams). Median postmenstrual age at time of laser was 35 weeks (IQR: 33-39 weeks). ERD was diagnosed at a median of 7 days (IQR: 5-7 days) after laser and was managed with steroids. Bevacizumab was also used for certain cases. Time to resolution ranged from 1 to 5 weeks. Macular pigment changes, atrophy, window defect on fluorescein angiography, and photoreceptor loss on optical coherence tomography were noted in some cases following ERD resolution. Excluding one patient who expired at 3 months, median length of follow-up was 10 years (IQR: 9-13.5 years). Overall, only one patient, who presented with less severe ERD, had normal vision.

CONCLUSIONS

ERD is an uncommonly reported complication following laser for ROP. Macular changes following ERD resolution may have negative visual consequences. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:698-705.].

Exudative Retinal Detachment Following Laser Photocoagulation for Retinopathy of Prematurity: A Rare Complication

Laser photocoagulation remains the standard of care for retinopathy of prematurity (ROP). Rarely, exudative retinal detachment (ERD) has been observed as a complication of laser treatment. The authors present the clinical course of an infant who developed severe, unilateral ERD after bilateral laser photocoagulation at 37 weeks postmenstrual age (PMA) for Type I ROP. The infant was managed with systemic and topical corticosteroids, and nearcomplete resolution of ERD was observed at 39 weeks. Continued follow-up until 62 weeks PMA with serial examination, fundus photography, and fluorescein angiography documented the time course of resolution and retinal sequelae of this rare complication. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:242-246.].