title: Treatment for stage 4A retinopathy of prematurity: laser and/or ranibizumab.
abstract: OBJECTIVE
  Stage 4A retinopathy of prematurity (ROP) is a critical phase where retinal detachment develops, but fovea is preserved. The present study aims to evaluate the effect of the first treatment choice (laser photocoagulation (LPC) or intravitreal ranibizumab (IVR)) applied in this critical phase on the prognosis of the disease.
  
  
  METHODS
  Records of patients diagnosed with stage 4A ROP and whose first treatment was applied in our clinic were evaluated retrospectively. All patients were referred to our clinic for the treatment of advanced ROP . While group 1 was composed of the patients who were administered LPC as first treatment, group 2 included patients where IVR was applied as first treatment. The patients in both groups were referred to surgical treatment in the presence of progression.
  
  
  RESULTS
  The present study included a total of 31 eyes in 16 patients with stage 4A ROP. Eighteen eyes of nine patients in group 1 were first applied LPC, and 13 eyes of seven patients in group 2 were first applied intravitreal ranibizumab. While anatomic outcomes of ten eyes in both groups were favorable, eight eyes in group 1 and three eyes in group 2 displayed progression and were referred to vitreoretinal surgery.
  
  
  CONCLUSIONS
  Laser and/or IVR treatment may be effective as a non-surgical treatment for stage 4A ROP. Especially stage 4A ROP until 6 clock hours can regress without surgical treatment. However, in stage 4A with involvement wider than 6 clock hours, non-surgical regression is difficult. Prospective controlled large series studies are necessary.
authors: Department of Ophthalmology, Adana Numune Training and Research Hospital, Ege Bagatur Caddesi Adana Numune Eğitim ve Araştırma Hastanesi Yüreğir, Adana, Turkey, 06520. esukgen@gmail.com.
authors: Emine Alyamaç
authors: EA
authors: Sukgen
authors: Department of Ophthalmology, Adana Numune Training and Research Hospital, Ege Bagatur Caddesi Adana Numune Eğitim ve Araştırma Hastanesi Yüreğir, Adana, Turkey, 06520.
authors: Yusuf
authors: Y
authors: Koçluk
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D058449:Intravitreal Injections; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D012178:Retinopathy of Prematurity / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab
keywords: Intravitreal ranibizumab; Laser photocoagulation; Retinopathy of prematurity (ROP); Stage 4A