Intravitreal bevacizumab to treat retinopathy of prematurity in 865 eyes: a study to determine predictors of primary treatment failure and recurrence

Abstract

Purpose: This study aimed To evaluate the rate and risk factors for primary failure and recurrence after intravitreal anti-VEGF injection in retinopathy of prematurity (ROP).Methods: This retrospective study was performed on 865 eyes from 441 patients with retinopathy of prematurity receiving intravitreal Bevacizumab from 2012 to 2019. Medical records of patients were evaluated.Results: Mean gestational age (GA) and birth weight of patients were 28±2 weeks and 1121±312 g, respectively. Thirty-ve eyes (4.04%) had a primary failure, including 18 eyes from 187 eyes in zone 1 (9.6%) and 17 eyes from 678 eyes in zone 2 (2.5%). The mean time of retreatment was 16.64±13.68 days in eyes without regression ROP. The remaining 830 eyes (95.95%) were included in recurrence analysis.The recurrence occurred in 33 eyes (3.97 %) of them in 20 patients, with the meantime of 77.52 days after the rst treatment (IVB). Presence of plus disease, history of oxygen therapy or phototherapy, and GA less than 32 were associated with signi cantly increased prevalence of treatment failure. The risk factor predicting recurrence are lower birth weight, zone 1 pretreatment, history of intubation, anemia, and sepsis.Conclusion: Intravitreal anti-VEGF is a successful treatment for ROP with a low rate of primary failure and recurrence. Attention to risk factors accompanied by special care to patterns of treatment failure and recurrence helps to achieve early detection of treatment failure and vigilant follow up for recurrence.

Outcome of eyes treated for Retinopathy of Prematurity in Posterior Zone I: An Eastern India study.

“…The reactivation rate after intravitreal anti-VEGF monotherapy for Zone I has been reported to be between 4% and 14.6%. [28][29][30] Much is not written on the reactivation rate for ROP in the posterior Zone I (Medline search with keywords anti-VEGF, bevacizumab, ranibizumab, and retinopathy of prematurity posterior Zone I). In our cohort, the reactivation rate was high (59.3%).…”

Evaluating the causes of retinopathy of prematurity relapse following intravitreal bevacizumab injection

“…On the other hand, another study showed a much lower recurrence rate (4.04%) after IVB injection in ROP cases. This lower recurrence rate might be related to the lower prevalence of Zone I ROP (21.6%) in the sample size [ 8 ]. Although the distribution of the various stages of ROP did not show any statistical difference between the two groups in our study (A-ROP prevalence 76.9% vs. 51.7% in recurrence and complete regression cases, respectively), this statistically insignificant result may be due to the small sample size and more advanced stages of ROP may increase the recurrence rate.…”

“…Besides, we have to take into account that these children are hospitalized due to respiratory problems or other systemic conditions that can worsen retinal hypoxia or ischemia. Premature infants are more prone to other exacerbating conditions, such as infections, and may have more severe forms of retinopathy due to the lower compliance of anti-oxidant metabolic pathways [ 8 ]. With lower oxygen saturation, the rate of mortality increases; with higher oxygen saturation, the rate of ROP increases [ 20 ].…”

“…IVB treatment could rapidly lead to the regression of vascular abnormality, especially in eyes with miotic pupils, and also lower the incidence of induced high myopia in type 1 ROP, compared with laser ablation. However, recurrence remains a major concern in the administration of IVB [ 8 ]. Different risk factors have been related to ROP recurrence, such as Zone I ROP, early need for treatment, and low Apgar score [ 9 ].…”