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ROPARD Online Education Section Module 2
Module 2 –
Peripheral Ablation
Peripheral ablation for retinopathy of
prematurity is based on the data from the Retinopathy of Prematurity Cryo Study. The
Retinopathy of Prematurity Cryo Study suggests the use of cryo ablation in the
periphery. With the advent of the laser indirect ophthalmoscope, cryotherapy is a
less desirable mode of peripheral ablation. In the situation where no other
treatment is available, cryotherapy perhaps has a place, but where both therapies are
available, laser ablation is much superior, as cryotherapy leads to an effusion following
treatment that can be damaging to the retina. Treatment with laser is best done with
the red diode laser, although green argon laser can also be used. The concern with
the green laser is that absorption in and around the lens by the tunica vasculosa lentis
may lead to cataract formation.
The treatment pattern for laser is
important. A near confluent treatment pattern yields the best result. The
photograph of the laser pattern in this module shows a laser pattern that is too widely
spaced. The laser spots should be placed approximately one-half of the laser spot
dimension apart. This pattern should be loosened however in the horizontal meridians
to avoid anterior segment ischemia, which can have varying degrees following treatment
ranging from cataract presentation to extreme hypotony and phthisis resulting after a
period of this hypotony. The child may need a second or sometimes even a third laser
treatment. These cases however are rare constituting probably fifteen percent at
most of the eyes treated with peripheral ablation.
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