A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Jennifer L. Simpson, MD1; Michele Melia, ScM2; Michael B. Yang, MD3; Angela N. Buffenn, MD, MPH4; Michael F. Chiang, MD5; Scott R. Lambert, MD6
Ophthalmology, April 2012, Vol 119, 873-877 © 2012 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To evaluate the role of cryotherapy in the current treatment of retinopathy of prematurity (ROP).
Methods: Literature searches of PubMed and the Cochrane Library were conducted on December 2, 2009 for articles published after 1984. The searches included all languages and retrieved 187 relevant citations. Thirteen articles were deemed relevant to the assessment question and were rated according to the strength of evidence. Four papers reported results from 2 large multicenter randomized clinical trials, and the remaining 9 articles reported results of 3 small randomized trials that directly compared cryotherapy and laser.
Results: Neither of the multicenter randomized clinical trials was a direct comparison of cryotherapy with laser. These studies were used to evaluate the comparative trials based on treatment criteria, study populations, and clinical results. Higher percentages of poor structural and functional outcomes generally were seen in eyes treated with cryotherapy compared with eyes undergoing laser treatment. Higher rates of systemic complications and myopia were also identified after treatment with cryotherapy.
Conclusions: Despite a relative paucity of level I evidence directly comparing cryotherapy and laser treatment for threshold ROP, the literature suggests that neonatal facilities should gain access to laser technology and laser-trained ophthalmic staff to achieve better outcomes for treatment of the disease.
1Department of Ophthalmology, School of Medicine, University of California, Irvine, California
2Jaeb Center for Health Research, Tampa, Florida
3Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, College of Medicine, Cincinnati, Ohio
4The Vision Center, Children's Hospital Los Angeles; Orbit and Eye Movement Institute, Strabismus and Pediatric Ophthalmology; Fellowship Program, Pediatric Ophthalmology and Strabismus; University of Southern California Keck School of Medicine, Los Angeles, California
5Casey Eye Institute, Oregon Health and Sciences University, Portland, Oregon
6Department of Ophthalmology, Emory University, Atlanta, Georgia