Evaluation of the efficacy of transpupillary hexagonal pattern laser coagulation of the retina in the treatment of active stages of retinopathy of prematurity

Aim: to evaluate the efficacy of transpupillary hexagonal pattern laser coagulation of the retina (LCR) in the treatment of active stages of retinopathy of prematurity (ROP). Patients and Methods: from 2017-2020, transpupillary LCR was performed for 161 infants (161 eyes) with an unfavorable course of ROP, active stages 2 and 3. All infants were divided into the study and control groups. Patients of both groups received laser treatment with the Integre Pro Scan 561 nm pattern system (Ellex, Australia). In the control group (n=83), LCR was performed with the chosen square matrix patterns 3×3 (totally 9 applications). In the study group (n=78), the "honeycomb" LCR was performed using a hexagonal pattern (totally 7 applications). Coagulation parameters in the study and control groups differed only in the interval between laser applications. The inter-spot distance was increased by 0.25 of the coagulum diameter in the study group as compared to the control group. The treatment efficacy was evaluated by changes in the clinical manifestations (flattening, decrease and disappearance of the extraretinal proliferation (ERP) ridge and demarcation ridge) and morphometric indicators (reduction in retinal thickness in the macular region) 3–4 weeks following LCR. Results: the efficacy of the hexagonal pattern LCR technique is comparable to that of the square pattern LCR: in both groups it was effective in 100% of patients with ROP stage 2 and 96% of patients with ROP stage 3. In patients treated with the hexagonal pattern LCR, the total number of coagulates, number of single coagulates, total energy load and the total treatment time were less than those in patients for whom the square matrix patterns were used. The hexagonal pattern shape is convenient for performing treatment close to the extraretinal proliferation ridge, as a topographically oriented LСR session can be performed on a case-by-case basis, considering individual characteristics of the pathological process location. The technique was optimal for treating the spherical retinal surface of a premature baby and provided an accurate and intuitive "docking" of every next pattern to the previous one. Conclusion: the hexagonal pattern LCR is a tissue-saving, dosed and high-precision technique which enables to achieve an adequate clinical effect minimizing the energy load on the retina of a premature baby. Keywords: active stages of retinopathy of prematurity, transpupillary pattern laser coagulation of the retina, hexagonal pattern, "honeycomb" pattern, matrix pattern, extraretinal proliferation (ERP) ridge. For citation: Tereshchenko A.V., Trifanenkova I.G., Sidorova Yu.A., Firsova V.V. Evaluation of the efficacy of transpupillary hexagonal pattern laser coagulation of the retina in the treatment of active stages of retinopathy of prematurity. Russian Journal of Clinical Ophthalmology. 2023;23(1):39–46 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-39-46