Longitudinal Development of Refractive Error in Children Treated With Intravitreal Bevacizumab or Laser for Retinopathy of Prematurity

Abstract

Purpose To compare the patterns of longitudinal refractive error development during the first 3.5 years in children with severe retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) or laser photocoagulation. Methods This prospective cohort study enrolled extremely preterm infants (birth weight < 1000 g, gestational age 23–27 weeks) with type 1 ROP from multiple hospitals in Dallas between 1999 and 2017; IVB group (N = 22); laser group (N = 26). Cycloplegic retinoscopy was conducted from 0.04 years corrected age and every 0.5 to 1.0 years thereafter until 3.5 years old. Right eye spherical equivalent (SEQ) and astigmatism, anisometropia, and better-eye visual acuity were analyzed over time. Results In all children, both eyes were treated with the same modality. At the final visit, the prevalence of myopia (SEQ ≤ −1D) was 82.7% in the laser group and 47.7% in the IVB group ( P < 0.05) with a mean SEQ of −8.0D ± 5.8D in the laser group versus −2.3D ± 4.2D in the IVB group ( P < 0.001). Longitudinal SEQ were best fit with a bilinear model. Before one year, the rate of SEQ change was −5.0D/year in the laser group, but only −3.5D/year in the IVB group (T = −5.14, P < 0.001); after one year, there was a significant flattening of these slopes (T = 6.23, P < 0.001). Anisometropia in the IVB group was significantly less than in the laser group ( P < 0.05). Final visual acuity in both groups was similar at 0.47 logMAR (∼ 20/60). Conclusions Children with severe ROP treated with IVB developed less myopic refractive error than those treated with laser largely because of a slower rate of refractive change during the first year of life. Translational Relevance These findings may inform decisions regarding ROP treatment timing and modality.

An Artificial Intelligence System for Screening and Recommending the Treatment Modalities for Retinopathy of Prematurity

“…However, compared with our study, the study by Young et al 40 not only lacked specific treatment guidance but also had a relatively small sample size. Currently, many studies are investigating the various effects of LP and IVI on infants with ROP, including visual acuity, ocular structure, refractive status, and even neural development 4–7,9–11 . However, these studies are mostly based on clinical data; therefore, the treatment decision of whether to implement LP or IVI for ROP still relies on clinical doctors.…”

“…LP is a conventional treatment, while IVI were introduced later and offer benefits such as faster regression of ROP lesions without the need for sedation. 4,5 Both treatments have advantages and disadvantages, [6][7][8][9][10] and selection should be made according to the ROP severity. The selection of treatment modalities is important because it affects the outcomes.…”

Refractive outcomes in infants treated for retinopathy of prematurity

“…Finally, since a higher degree of myopia in aggressive posterior ROP than in type 1 ROP [11] was reported in the subgroup analysis, future studies should elucidate whether the observed refractive status in the treated eyes is a function of the treatment modality or protocol or depends on the zone of involvement (The anti-VEGF-treated eyes with posterior ROP developed a significantly lower SEQ compared to the anti-VEGF-treated eyes with peripheral zone II [23]) or stage of ROP (With random allocation of the eyes with stage 2 or 3 ROP to the anti-VEGF or laser treatment group, comparable spherical and cylindrical refractive outcomes were found at a postmenstrual age of 90 weeks [45]), or both. Moreover, the impact of child age factor should be investigated over a long followup, as after 1.1 years, the rate of SEQ change was significantly slower for both treatment modalities [1].…”

“…Anti-VEGF monotherapy in the eyes treated for severe ROP leads to a lower prevalence of myopia compared to laser treatment. Similarly, lower anisometropia develops after anti-VEGF monotherapy, with similar levels of significant astigmatism between the two treatment modalities [1]. In school children with a history of lasertreated type 1 ROP, the eyes developed a significantly higher degree of myopia compared to those with a history of anti-VEGF monotherapy.…”

“…Aberrations in refractive development are serious sequelae of retinopathy of prematurity (ROP) [1]. The eyes treated with ROP are likely to develop myopia during early childhood.…”