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372 Section IX ■ Miscellaneous Procedures

best in the posterior pole. A + symbol is added to the

ROP stage number to designate the presence.

b. “Preplus” disease: More arterial tortuosity and more

venous dilation than normal, but insufficient for

diagnosis of “plus”disease; may progress to frank

“plus”disease.

c. Aggressive posterior ROP: Also called type “II ROP”

or “rush disease.”This is an uncommon, severe form

of ROP, characterized by its posterior location,

prominent plus disease in all four quadrants, out of

proportion to the peripheral retinopathy, and rapid

progression.

5. Additional features

a. Iris vascular engorgement (Fig. 52.3) and pupillary

rigidity (manifested by poor dilation after mydriatic

instillation) are harbingers of active, advanced ROP(6).

b. Corneal and lenticular opacity may be present in

the eyes of any premature infant regardless of the

presence of ROP (7).

C. Laser Treatment of ROP (8,9)

Ablation of the avascular portion of the retina decreases the

production of angiogenic growth factors and reduces the

risk of retinal detachment. In patients with ROP, cryotherapy

has been replaced with transpupillary laser photocoagulation

delivered via an indirect ophthalmoscope, with improved

structural and functional outcomes.

1. Indications for Laser Treatment

Early Treatment for Retinopathy of Prematurity Study

guidelines (10,11):

a. Peripheral retinal ablation should be considered for

any eye with type I ROP:

(1) Zone I: Any stage of ROP with plus disease

(2) Zone I: Stage 3 ROP with or without plus

disease

(3) Zone II: Stage 2 or 3 ROP with plus disease

b. Consider close monitoring (serial examinations) as

opposed to retinal ablation for any eye with type 2

ROP, as defined below. Regression of ROP can

occur in about 50% of these patients without treatment (10); treatment should be considered if progression to type 1 status occurs.

(4) Zone 1: Stage 1 or 2 ROP without plus disease

(5) Zone 2: Stage 3 ROP without plus disease

c. Treatment is recommended within 72 hours of

detection of a stage of ROP requiring ablative therapy, when possible, in order to minimize the risk of

retinal detachment.

2. Contraindications

a. Stage 4 to 5 ROP, in which case laser may be done

(intraoperatively) in conjunction with incisional

surgery (scleral buckle, vitrectomy, or both) (12)

b. Vitreous hemorrhage sufficient to obscure a view of

the retina

c. Instability of medical condition sufficient to make

the stress of sedation and laser inadvisable

d. Lethal medical illness

3. Personnel

a. Ophthalmologist