2.8. Indications for laser treatment in ROP

The indications for ROP treatment were formulated for the first time by the Multicenter Trial of Cryotherapy for ROP, as a threshold disease [6].

Adverse events related to laser treatment were cited in the literature: anterior uveitis, cataract, vitreous hemorrhage, retinal detachment [7]. Anterior uveitis was rarely identified in cases that required extensive laser photocoagulation, such as aggressive posterior-ROP [2]. The risk of cataract development is very low, especially when using the infrared laser which is absorbed deep into the choroid and not in the crystalline lens [2, 7]. Vitreous hemorrhage and retinal detachment represent rather a failure of laser to stop ROP progression than a

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2.11. Advantages of indirect laser photocoagulation over cryotherapy for ROP treatment

Cryotherapy was the first method that stopped the progression of ROP toward blindness [6]. The rationale was to destroy the non-vascular retina by applications of cryo on the sclera.

Indirect laser photocoagulation of the retina proved to be as effective as cryo in preventing ROP-related blindness, but with significantly fewer side effects. The pressure exerted by the cryoprobe on the infants' sclera was associated with high risk of myopia. Cryotherapy itself is more laborious than laser and requires more time and general anesthesia. By consequence, more anesthesia-related incidents were reported during cryo as compared to laser. In posterior ROP, it is very difficult (sometimes impossible) to reach the retina in the posterior pole with the cryoprobe. Therefore, posterior non-vascular retina may remain untreated with a high risk of

For all these reasons, currently indirect laser photocoagulation replaced cryotherapy in the

ROP offers an eloquent example in which laser energy has revolutionized the treatment of an extremely serious disease, with significant socioeconomic and life quality positive impact.

3. Personal experience in the treatment of ROP with indirect diode laser

This study was carried out at the "Iuliu Hatieganu" University of Medicine and Pharmacy (Cluj-Napoca, Romania) in the Ophthalmology and Neonatology Departments. All laser therapies were performed by two ophthalmologists in the Neonatology Department. Before enrollment in the study, informed consent was obtained from the parents/tutors. The study is approved by the Ethical Committee of "Iuliu Hatieganu" University of Medicine and

This study includes all the consecutive premature infants with ROP who required laser photocoagulation between January 1, 2006 and December 31, 2017. The screening protocol was based on the following criteria: GA less or equal to 33 weeks and, BW less or equal to 1500 g.

complication by itself [2].

ROP progression.

3.1. Setting

Pharmacy.

3.2. Study sample

treatment of ROP in most of settings.

The Early Treatment for ROP Randomized Trial Study affirmed that the criteria for treatment defined as "threshold" may no longer be the ideal indication for treatment. Therefore, the criteria for "pre-threshold" ROP were defined with the recommendation to initiate treatment also in these circumstances. The results of treatment in the pre-threshold ROP were significantly better than the threshold ones [2, 8, 9].
