for the BEAT-ROP Cooperative Group IMPORTANCE Children born prematurely who develop retinopathy of prematurity (ROP) often develop myopia, and those who require laser treatment may develop very high myopia, which has considerable clinical consequences.OBJECTIVE To report refractive outcomes in preterm infants who developed ROP in zone I or zone II posterior as stage 3+ ROP or aggressive posterior ROP (APROP). DESIGN, SETTING, AND PARTICIPANTSAll infants received intravitreal bevacizumab or laser therapy in a prospective, stratified, randomized, controlled, masked, multicenter clinical trial, Bevacizumab Eliminates the Angiogenic Threat for ROP (BEAT-ROP). Children who received intravitreal bevacizumab or laser in the BEAT-ROP clinical trial, with treatment randomized by infant, underwent cycloplegic retinoscopic refraction at a mean age of 2½ years. Fifteen centers with both pediatric and vitreoretinal ophthalmologists participating in level 3 neonatal intensive care units in academic centers with institutional review board approval were included in the trial. Of the originally enrolled 150 infants (300 eyes) in the BEAT-ROP clinical trial, 13 infants (26 eyes) died (6 received intravitreal bevacizumab; 7 received laser) and 19 eyes had intraocular surgery (6 infants bilaterally). Thus, 45 eyes (19 infants bilaterally) were excluded, leaving 131 infants (255 eyes, including 21 eyes that received a successful second treatment for recurrence).INTERVENTIONS Follow-up of the BEAT-ROP cohort. MAIN OUTCOMES AND MEASURES Spherical equivalent refractive outcomes and their distribution by ROP zone and treatment.RESULTS Refractions were available for 109 of 131 eligible infants (83.2%) and 211 of 255 eyes (82.7%). Mean (SD) spherical equivalent refractions were as follows: zone I, −1.51 (3.42) diopters (D) in 52 eyes that received intravitreal bevacizumab and −8.44 (7.57) D in 35 eyes that received laser treatment (P < .001); and zone II posterior, −0.58 (2.53) D in 58 eyes that received intravitreal bevacizumab and −5.83 (5.87) D in 66 eyes that received laser treatment (P < .001). Very high myopia (Ն−8.00 D) occurred in zone I in 2 of 52 (3.8%) eyes that received intravitreal bevacizumab and in 18 of 35 (51.4%) eyes that received laser treatment (P < .001). Very high myopia occurred in zone II posterior in 1 of 58 (1.7%) eyes that received intravitreal bevacizumab and in 24 of 66 (36.4%) eyes that received laser treatment (P < .001).CONCLUSIONS AND RELEVANCE More very high myopia was found in eyes that received laser treatment than in eyes that received intravitreal bevacizumab. This difference is possibly related to anterior segment development that is present with intravitreal bevacizumab but minimal or absent following laser treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00622726

PURPOSE To determine (1) incidence, (2) risk factors, (3) risk period, and (4) characteristics of recurrent retinopathy of prematurity (ROP) treated by intravitreal bevacizumab (IVB) monotherapy. DESIGN Retrospective case series. PARTICIPANTS Premature infants developing Type 1 ROP [subdivided into ROP stage 3+ and aggressive posterior ROP (APROP)] in zone I or zone II posterior, receiving IVB monotherapy, and followed for at least 65 weeks adjusted age (AA). METHODS Retrospective review of infants who developed recurrence of Type 1 ROP following IVB monotherapy was performed including examination of RetCam fundus photographs and fluorescein angiograms. MAIN OUTCOMES MEASURES Incidence, risk factors, risk period, and characteristics of recurrent ROP. RESULTS IVB monotherapy in 241 infants (471 eyes) was reviewed. (1) Recurrence incidence was 8.3% (20/241) for infants and 7.2% (34/471) for eyes. (2) Recurrence risk factors of greatest significance were appearance of neovascularization as APROP (P=0.006), extended duration of hospitalization (P=0.01), and lower birth weight (P=0.024). (3) Recurrence risk period was between ≈45 and ≈55 weeks AA [90.0% (18/20) for infants and 94.1% (32/34) for eyes] with mean recurrence of 51.2 weeks AA (±4.6; range 45.7 to 64.9), and mean interval of 16.2 weeks (±4.4) between treatments. (4) Recurrence characteristics included plus disease, (20/20 infants; 100%) and neovascularization appeared at the following sites: (i) ROP stage 3+ with confluent neovascularization recurred both at the advancing edge and at the initial ridge and extra-retinal fibrovascular proliferative complex (12/14 infants; 85.7%). However, (ii) APROP (6/6 infants; 100%) [and ROP stage 3+ with non-confluent neovascularization (2/14 infants; 14.3%)] recurred only at the advancing edge. Also, the anterior extent of retinal vascularization was decreased (mean 1.76 versus 4.48 disc diameters [DD]), and the rate of retinal vascularization was delayed (mean 0.11 versus 0.23 DD/week) in those with versus without recurrence, respectively. Following retreatment with IVB, plus disease persisted, neovascularization regressed, and retinal vascularization proceeded minimally and slowly. CONCLUSIONS Premature children developing severe ROP are being treated successfully with IVB monotherapy. However, recurrence is not uncommon, so vigilant follow-up is necessary to ensure timely re-treatment when needed. Knowledge of recurrence incidence, risk factors, risk period, and characteristics allows tailored clinical management.

Objective The effectiveness of annual diabetic eye exams in children is unclear. We sought to determine the prevalence and onset of ocular pathology in children with diabetes mellitus (DM), identify risk factors for ocular disease, and recommend a screening regimen for asymptomatic children. Design Retrospective consecutive cohort study. Subjects Children less than age 18 years with type 1 or 2 DM examined over a 4 year period. Methods All children underwent a complete eye exam, including dilated fundoscopy and cycloplegic refraction. A literature review was performed, identifying the youngest reported age and shortest reported duration of DM prior to the diagnosis of diabetic retinopathy. Main outcome measures Prevalence of diabetic retinopathy, cataract, high refractive error, and strabismus. Results 370 children (mean age 11.2 years, range 1–17.5) had 693 examinations, with mean DM duration 5.2 years (range 0.1–16.2), mean HbA1c 8.6 (range 5 to ≥14). No children had diabetic retinopathy. 12 had cataract; 5 required extraction but were identified by decreased vision, not diabetic screening. 19 had strabismus; only one was microvascular paralytic strabismus. 41 had high refractive error. There were no associations between these conditions and duration or control of DM. In the literature, the youngest age at diagnosis of severe diabetic retinopathy was 15 years and the shortest duration of disease was 5 years. Conclusion Diabetic retinopathy is rare in children regardless of duration and control of DM. Based upon our study and literature review, screening examinations for type 1 diabetics could begin at age 15 years or at 5 years after the diagnosis of DM, whichever occurs later, unless the child is judged by the endocrinologist as being at unusally high risk. Other ocular complications are identifiable through existing amblyopia screening methods.

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