Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación / Optic neuritis in paediatric patients: Experience over 27 years and a management protocol

Introducción y objetivos: Se presenta nuestra experiencia en neuritis óptica (ON) y se elabora un protocolo diagnóstico-terapéutico, que contempla descartar otras causas, principalmente infecciosas y se elabora una hoja informativa para padres.Material y métodoEstudio descriptivo retrospectivo de los pacientes con ON en 27 años (1990-2017). Revisión de evidencia científica para elaboración del protocolo y hoja informativa.ResultadosEn nuestra sección de neuropediatría se valoraron 20.744 niños en 27 años, 14 con ON: 8 ON aisladas, una esclerosis múltiple (EM), un episodio clínicamente aislado (CIS), 3 encefalomielitis agudas diseminadas y un paciente con ON aislada que el año anterior había sufrido una encefalomielitis aguda diseminada. Edades entre 4-13 años, 50% varones. Mayores de 10 años, 8 pacientes: 7 ON aisladas y un EM. Bilaterales 9, retrobulbares 3. Resonancia magnética cerebral normal en 7, solo afectación del nervio óptico en 2 y con desmielinización del SNC en 5 casos. Recibieron corticoterapia 13/14. Un caso vacunado de meningococo-C el mes anterior. Todos evolucionaron favorablemente, salvo la EM. Se presentan el protocolo y la hoja de información.ConclusionesHabitual curso favorable. En niños a partir de 10 años, con factores de riesgo de desarrollar EM o neuromielitis óptica (presencia de hiperseñales en RM cerebral, bandas oligoclonales, anti-NMO, recurrencia de ON), se consensúa con Neurología el inicio de tratamiento inmunomodulador. Utilidad del protocolo para la toma de decisiones diagnósticas, de seguimiento y tratamiento, de una patología poco frecuente pero con posibles repercusiones importantes. Importancia de la protocolización y hojas informativas. (AU)

Introduction and objective: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents.Material and methodsWe conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet.ResultsOur neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients’ age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided.ConclusionsON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important. (AU)

Optic neuritis in paediatric patients: Experience over 27 years and a management protocol. / Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación.

INTRODUCTION AND OBJECTIVE: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. MATERIAL AND METHODS: We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. RESULTS: Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. CONCLUSIONS: ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.

Revisión de los principales test clínicos para evaluar la visión del color / Review of the main colour vision clinical assessment tests

Introducción: Las deficiencias congénitas en la visión del color afectan a un 8% de la población masculina y a un 0,5% de la femenina. El estudio de la visión del color es un proceso complejo debido a diversos factores: la propia psicofísica de la visión y la dificultad de establecer modelos matemáticos para su análisis, la vaga correlación de los resultados entre unos test y otros y la influencia de factores externos como la iluminación, la condición de los test o la experiencia del examinador y del paciente. En el presente documento se realiza una revisión simplificada de los principales test disponibles en la práctica clínica para evaluar la visión del color. Material y métodos: Tras realizar una filtrada revisión preliminar de la bibliografía relacionada con el estudio de la visión del color en el motor de búsqueda PubMed, se determinaron los test mayormente utilizados en la práctica clínica. Se realizó una interpretación atendiendo a su frecuencia de uso y el propósito para el que eran utilizados. A continuación, se procedió con un estudio bibliográfico de cada test en particular, atendiendo al diseño de los estímulos presentados, su población diana y su sensibilidad y especificidad. Resultados De las 95 publicaciones que mostró el buscador PubMed, en 41 de ellas los investigadores utilizaron test de colores en su metodología. De los 64 test de color utilizados, 19 eran diferentes (contando como distintos los test adaptados por grupos de investigación, 4, y aquellos realizados online, 2). El orden de empleo de los test es el siguiente: test de Ishihara (10,88%), Farnsworth-Munsell (7,04%), Farnsworth-Munsell 100 Hue (6,4%), Cambridge Colour Test (3,84%), Hardy-Rand-Rittler (3,2%), test propios desarrollados por los grupos (2,56%), el anomaloscopio (1,28%), los test online (1,28%) y, finalmente, Colour Assessment and Diagnosis (0,64%), Pflüger Trident Colour Plates (0,64%), Toothguide Training Box (0,64%), Lanthony Desaturated D-15 (0,64%), City University Test (0,64%), Universal Colour Discrimination Test (0,64%) y Rabin Cone Contrast Test (0,64%). Conclusiones El gold standard en cuanto a la evaluación de la visión del color es el anomaloscopio, instrumento incompatible con la práctica clínica diaria. Su manejo es relativamente complicado, exige disponibilidad de tiempo para su aplicación y es difícilmente comprensible por población infantil. Sin embargo, es posible alcanzar una fiel aproximación mediante la combinación de algunos de los test enumerados en este artículo. Los test expuestos son una buena alternativa para determinar la presencia de discromatopsias en ambientes cercanos a la práctica clínica diaria o en entornos menos controlados que un estudio clínico. El inconveniente principal del amplio elenco de test disponibles para el estudio de la visión del color es la dificultad para comparar los resultados entre test, ya que los datos publicados suelen tener unidades distintas, requiriendo experiencia para su correcta interpretación. En la actualidad, no existe unanimidad sobre qué test de color resulta ser el más completo; es recomendable utilizar al menos 2 para asegurar los diagnósticos y tener una información más completa sobre la percepción visual de los pacientes

Introduction: Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. Material and methods: Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. Results: From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth-Munsell (7.04%), Farnsworth-Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy-Rand-Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pflüger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). Conclusions: The Anomaloscope is the "gold standard" in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients

Review of the main colour vision clinical assessment tests. / Revisión de los principales test clínicos para evaluar la visión del color.

INTRODUCTION: Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. MATERIAL AND METHODS: Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. RESULTS: From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth-Munsell (7.04%), Farnsworth-Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy-Rand-Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pflüger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). CONCLUSIONS: The Anomaloscope is the "gold standard" in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients.

[A protocol for the treatment of retinopathy of prematurity in Spain]. / Protocolo de tratamiento de la retinopatía del prematuro en España.

OBJECTIVE: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. MATERIAL AND METHOD: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. RESULTS: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. CONCLUSIONS: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Protocolo de tratamiento de la retinopatía del prematuro en España / A protocol for the treatment of retinopathy of prematurity in Spain

Objetivo: Realizar un protocolo de tratamiento de la retinopatía del prematuro (ROP) consensuado por la mayor parte de oftalmólogos españoles dedicados al tema. Material y método: Se realizó un borrador del protocolo según la experiencia de los participantes y las publicaciones actualizadas. Este borrador fue corregido por los participantes en el protocolo y se llegó al documento final consensuado por todos los participantes. Resultados: Se presentan las directrices generales para realizar el tratamiento de la ROP, incluyendo criterios de tratamiento, metodología de actuación, calendario de actuación y seguimiento. Conclusiones: Es importante disponer de un protocolo de actuación común en el tratamiento de la ROP para mejorar la actuación y evitar errores. Aunque cada centro hospitalario deba adaptar el protocolo a su actividad clínica, es recomendable que existan un mínimo de procedimientos consensuados por todos los oftalmólogos dedicados a la ROP (AU)

Objective: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. Material and method: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. Results: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. Conclusions: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain (AU)

Programa de cribado para la retinopatía del prematuro en España / Screening program for retinopathy of prematurity in Spain

Objetivo: Realizar un protocolo de cribado de la retinopatía del prematuro (ROP), consensuado por la mayor parte de oftalmólogos españoles dedicados al tema. Material y método: Se realizó un borrador del protocolo según la experiencia de los participantes y las publicaciones actualizadas. Este borrador fue corregido por los participantes en el protocolo y se llegó al documento final consensuado por todos los participantes. Resultados: Se presentan las directrices generales para realizar el cribado de la ROP, incluyendo criterios de inclusión y exclusión, metodología de exploración y calendario de actuación. Conclusiones: Es importante disponer de un protocolo de actuación común en el cribado de la ROP para mejorar la actuación y evitar errores. Aunque cada centro hospitalario deba adaptar el protocolo a su actividad clínica es recomendable que existan un mínimo de procedimientos consensuados por todos los oftalmólogos dedicados a la ROP (AU)

Objective: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. Material and method: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. Results: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. Conclusions: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain (AU)

Screening program for retinopathy of prematurity in Spain.

OBJECTIVE: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. MATERIALS AND METHODS: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. RESULTS: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. CONCLUSIONS: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

¿Es la persistencia de ductus arterioso un factor de riesgo para la retinopatía del prematuro? / Is patent ductus arteriosus a risk factor for retinopathy of prematurity?

Introducción: Evaluar si la presencia de persistencia de ductus arterioso (PDA) aumenta la proporción de retinopathy of prematurity (ROP, «retinopatía del prematuro») o su gravedad. Pacientes y método: Se incluyó en el estudio una cohorte consecutiva de prematuros diagnosticados de PDA por ecocardiograma nacidos en el Hospital Universitario Miguel Servet desde enero de 2006 hasta mayo de 2009. Comparamos la proporción y gravedad de ROP en este grupo en comparación con un grupo control sin PDA aleatoriamente elegido. Resultados: Estudiamos un total de 131 prematuros: 79 con PDA y 52 sin PDA. Encontramos relación estadísticamente significativa entre la presencia de PDA y la proporción de ROP (p=0,03) (OR=2,41; 95% CI 1,08–5,38), sin que existieran diferencias significativas en la edad gestacional (EG) entre los grupos. Sin embargo, al usar un modelo de regresión múltiple ajustado a la EG, hay una relación significativa entre ROP y EG (β=−0,322; p=0,003), pero no existe relación estadísticamente significativa entre ROP y PDA (p=0,073 para proporción de ROP y p=0,20 para estadio de ROP). Conclusiones: La presencia de PDA no aumenta el riesgo de desarrollar ROP ni su gravedad, una vez que se considera el efecto de la EG en la presencia de PDA (AU)

Objective: To evaluate whether the presence of patent ductus arteriosus (PDA) increases the rate of retinopathy of prematurity (ROP) or its severity. Patients and method: A consecutive cohort of premature infants diagnosed with PDA by echocardiography born in the Miguel Servet University Hospital from January 2006 to May 2009 was included in the study. We compared the rate and severity of ROP in this group of patients with a control group of randomly-chosen premature infants with a normal echocardiography. Results: We evaluate a total of 131 premature infants (79 with PDA and 52 without PDA). We found a statistically significant association between the presence of PDA and the rate of ROP (p=0.03) (OR=2.41; 95% CI 1.08–5.38). However, using a multiple regression model adjusted for the gestational age (GA), a significant reverse association was found between ROP and GA (β=−0.322; p=0.003), but there was no statistically significant correlation between ROP and PDA (p=0.073 for rate of ROP and a p=0.20 for stage of ROP). Conclusions: The presence of PDA does not increase the risk of developing ROP or its severity, once considered the effect of gestational age in PDA (AU)

[Is patent ductus arteriosus a risk factor for retinopathy of prematurity?]. / ¿Es la persistencia de ductus arterioso un factor de riesgo para la retinopatía del prematuro?

OBJECTIVE: To evaluate whether the presence of patent ductus arteriosus (PDA) increases the rate of retinopathy of prematurity (ROP) or its severity. PATIENTS AND METHOD: A consecutive cohort of premature infants diagnosed with PDA by echocardiography born in the Miguel Servet University Hospital from January 2006 to May 2009 was included in the study. We compared the rate and severity of ROP in this group of patients with a control group of randomly-chosen premature infants with a normal echocardiography. RESULTS: We evaluate a total of 131 premature infants (79 with PDA and 52 without PDA). We found a statistically significant association between the presence of PDA and the rate of ROP (p=0.03) (OR=2.41; 95% CI 1.08-5.38). However, using a multiple regression model adjusted for the gestational age (GA), a significant reverse association was found between ROP and GA (ß= -0.322; p=0.003), but there was no statistically significant correlation between ROP and PDA (p=0.073 for rate of ROP and a p=0.20 for stage of ROP). CONCLUSIONS: The presence of PDA does not increase the risk of developing ROP or its severity, once considered the effect of gestational age in PDA.

[Diode laser therapy in retinopathy of prematurity: more than a decade of experience]. / Tratamiento con láser diodo en la retinopatía del prematuro: más de una década de experiencia.

BACKGROUND: Retinopathy of prematurity (ROP) is one of the most important causes of blindness in childhood. The introduction of diode laser has represented a significant advance in its treatment. The aim of the present study was to evaluate our results in the treatment of this entity after more than a decade of experience. PATIENTS AND METHODS: One hundred eighty-two eyes in 92 premature infants with ROP treated with diode laser in the Hospital Universitario Miguel Servet from 1992 to 2003 were studied. The characteristics of the population (gestational age, birth weight, sex, stage and affected zone) and treatment outcomes were analyzed. The change in the criteria indicating this treatment was also analyzed. RESULTS: In the treated population, mean gestational age (27.9 weeks) and birth weight (1015.9 g) were similar to those in other published studies. A favorable outcome was achieved in 169 of the 182 cases (92.8 %). The change in criteria increased the proportion of favorable outcomes to 96.1 %. DISCUSSION: Diode laser therapy is currently the treatment of choice in ROP. This treatment, based on guidelines for earlier intervention, provide greater efficacy without increasing morbidity.

Tratamiento con láser diodo en la retinopatía del prematuro: más de una década de experiencia / Diode laser therapy in retinopathy of prematurity: More than a decade of experience

Antecedentes: La retinopatía del prematuro (ROP) constituye una de las causas más importantes de ceguera en la infancia. La introducción del láser diodo ha constituido un avance significativo en su tratamiento. El presente estudio pretende evaluar nuestros resultados en el tratamiento de esta patología, con más de una década de experiencia. Pacientes y métodos: Se han estudiado 182 ojos de 92 prematuros con ROP tratados con láser diodo en el Hospital Universitario Miguel Servet desde 1992 hasta 2003. Se analizan las características de la población (edad gestacional, peso al nacimiento, sexo, estadio y zona de la enfermedad) y el resultado del tratamiento. Se evalúa además el cambio en los criterios de indicación del mismo. Resultado: La población tratada tiene una media de edad gestacional (27,9 semanas) y peso al nacimiento (1.015,9 g) similares a las de otros autores. Se ha logrado evolución favorable en 169 de 182 casos (92,8 %). Con el cambio en los criterios ha aumentado la proporción de evoluciones favorables al 96,1 %. Discusión: Actualmente el láser diodo es el tratamiento de elección en la ROP. El tratamiento, basándose en pautas de actuación más precoces, proporciona mayor eficacia sin aumentar la morbilidad

Background: Retinopathy of prematurity (ROP) is one of the most important causes of blindness in childhood. The introduction of diode laser has represented a significant advance in its treatment. The aim of the present study was to evaluate our results in the treatment of this entity after more than a decade of experience. Patients and methods: One hundred eighty-two eyes in 92 premature infants with ROP treated with diode laser in the Hospital Universitario Miguel Servet from 1992 to 2003 were studied. The characteristics of the population (gestational age, birth weight, sex, stage and affected zone) and treatment outcomes were analyzed. The change in the criteria indicating this treatment was also analyzed. Results: In the treated population, mean gestational age (27.9 weeks) and birth weight (1015.9 g) were similar to those in other published studies. A favorable outcome was achieved in 169 of the 182 cases (92.8 %). The change in criteria increased the proportion of favorable outcomes to 96.1 %. Discussion: Diode laser therapy is currently the treatment of choice in ROP. This treatment, based on guidelines for earlier intervention, provide greater efficacy without increasing morbidity