[Prognostic factors for laser treatment in retinopathy of prematurity]. / Factori prognostici ai tratamentului laser în retinopatia prematuritatii.

PURPOSE: The paper aims to determine the anatomical results of the eyes treated by laser photocoagulation for "threshold" retinopathy of prematurity (ROP) and to identify the potential risk factors for the unfavorable outcomes. MATERIAL/METHOD: A retrospective study including all the consecutive ROPs that were treated by laser photocoagulation between January the 1st 2006 and September the 1st 2009 has been conducted. The followed criteria has been the anatomical result after the laser treatment. The outcomes have been correlated with: the gestational ages, the birth weights, the moment of treatment (postnatal and post-conceptional ages), the sex of the premature infants, the stage and zone of ROR. RESULTS The total number of prematurely newborns that met the screening criteria for ROP in the above-mentioned period has been 474. Of these, 350 (74%) presented no ROP and the remaining 124 (26%) developed various stages of the disease. Within the ROP group, 54 patients required laser therapy (44% of the retinopathies, representing 11% of all the prematures). The anatomical outcome has been favorable in 84% of the treated eyes, the remaining 16% presenting the progression of ROP The results of the treatment depended on the type of ROP, being significantly better in the classic disease as in the agressive posterior disease (APD) (p < 0.05). The gender also influenced the outcome: the results were better in girls as compared with boys (p < 0.05). The precocity of the laser treatment (evaluated by the postnatal and postconceptional age) has positively influenced the ROP evolution (p < 0.05). CONCLUSIONS: Laser photocoagulation has proved its efficacy in the treatment of ROP on our cases. The factors that have negatively influenced the postlaser outcome were: the aggressive posterior disease, the delayed moment of the laser therapy and the male gender.

[Treatment of choroidal neovascular membranes]. / Tratamentul membranelor neovasculare coroidiene.

PURPOSE: The purpose is to present our experience in diagnosis and treatment of choroidal neovascular membranes of various etiology. MATERIAL AND METHODS: This is a retrospective study consisting of 165 patients that were diagnosed with choroidal neovascular membranes (CNM). From this patients, 62 were treated between 2001-2005 for CMN of different etiology: age-related macular degeneration (AMD), myopia, presumed ocular histoplasmosis syndrome, angioid streaks, viteliform dystrophy. The diagnosis was based on the clinical examination (direct and indirect ophthalmoscopy, direct and indirect biomicroscopy) and angiofluorography. The treatment was either PDT for sub-foveolar membranes, or laser coagulation with YAG532 laser for juxta and para-foveolar well defined membranes, or combined treatment for large minimal classic membranes with a well defined juxta para-foveolar component or a component on the feeder vessels. PDT was done with verteporfin (Visudyne, Novartis Pharma AG) activated with a diode laser of 689 nm (Activis, Quantel medical) and the laser coagulation was done with a Visulas YAG 532 Carl Zeiss laser. RESULTS: Results can be evaluated from two points of view: changes in the neovascular membrane (enlargement and activity signs) and the changes in VA. Last researches are based not only on AV but also on the quality life. The membranes are closed with PDT in 90% of the cases in the first week but there are rebounds in almost 100% of the cases at 3 months. This calls for multiple treatments. After two or three treatments the signs of activity (hemorrhage and exudation) drop and 60% of the membranes will close. After laser coagulation the CMN is closed completely in 70% of the patients and in 20% of the cases there is a rebound in the first month and in 30% of the cases the rebound appears in the next 2 years. The visual acuity has improved at 33% of cases, remained the same in 33% of cases and worsened in the rest of the treated eyes. The results are compatible with TAP and VIP results where after 24 months the average VA of those treated with verteporfirin was lower than at the beginning but twice as good compared with placebo. CONCLUSIONS: For four year we had at our disposal methods with which we can improve (33%) the VA in patients with CMN, at some of them we could maintain (33%) the visual acuity and at the rest of the patients, even though the visual acuity is lower, it will be still higher then the one during the natural course of the disease.