Outcomes after Intravitreal Bevacizumab versus Laser Photocoagulation for Retinopathy of Prematurity

Abstract

Purpose To determine the relative effectiveness, major complications, and refractive errors associated with intravitreal bevacizumab (IVB) versus panretinal photocoagulation (PRP) to treat Type 1 retinopathy of prematurity (ROP). Subjects Consecutive infants with Type 1 ROP who received either IVB or PRP between January 2008 and December 2012 and had at least six months of follow-up. Design Retrospective case series. Methods The data from infants treated with either IVB or PRP for Type 1 ROP between January 2008 and December 2012 were recorded from two medical centers in Atlanta, Georgia. Main Outcome Measures Recurrence rate, complication rate, refractive error. Results A total of 54 eyes (28 patients) with Type 1 ROP were evaluated: 22 eyes (11 patients) received IVB, and 32 eyes (17 patients) received PRP. Among the 22 eyes treated with IVB, 16 eyes had Zone I ROP and 6 eyes had posterior Zone II ROP. The number of Zone I and Zone II ROP eyes treated with PRP were 5 and 27 eyes, respectively. Mean gestational age, birth weight, postmenstrual age at the initial treatment, and follow-up period for the infants receiving IVB were 24.2 weeks, 668.1 grams, 35.1 weeks, and 21.7 weeks, respectively, and for the infants receiving PRP were 24.8, 701.4 grams, 36.1 weeks, and 34.5 weeks, respectively. ROP recurred in 3/22 (14%) IVB-treated eyes and in 1/32 (3%) PRP-treated eyes. None of IVB-treated eyes progressed to retinal detachment or developed macular ectopia. Only one eye went on to retinal detachment and five eyes developed macular ectopia in PRP-treated eyes. Mean spherical equivalent and postgestational age at the last refraction for IVB-treated eyes were −2.4 D and 22.4 months, respectively, and for PRP-treated eyes were −5.3 D and 37.1 months, respectively. Mean spherical equivalent for Zone I ROP eyes treated with IVB and PRP were −3.7 D and −10.1 D, respectively, and for Zone II ROP eyes were 0.6 D and −4.7 D, respectively. Conclusions Both IVB and PRP are effective treatment options for Type 1 ROP with low complication rates. Zone I ROP was associated with high minus refractive errors in eyes treated with either IVB or PRP.

Refractive Error in Patients with Retinopathy of Prematurity after Laser Photocoagulation or Bevacizumab Monotherapy

“…However, the difference between laser and intravitreal anti-VEGF injection remains unclear. Several studies have examined the refractive status of treated ROP eyes after laser or anti-VEGF therapy, but direct comparisons are scarce [18,19,27]. In the BEAT-ROP report [19], no significant difference was found in the severity of myopia between zone 1 and posterior zone 2 in infants without recurrence, and the mean SEQ was -0.974 dpt in the IVB group and -5.862 dpt in the laser group at the age of 2.5 years.…”

Effect of Single Intravitreal Bevacizumab on Ophthalmic and Middle Cerebral Arterial Blood Flow in Retinopathy of Prematurity

“…However, ablative treatment was not found to be effective enough to prevent some aggressive ROP cases progressing to retinal detachment [2,20]. In recent years, studies showed higher rates of favorable outcomes in ROP after IVB treatment as compared to laser ablation, especially in zone I and posterior zone II cases [5,21,22]. We found IVB treatment to be a successful treatment option in ROP in our study.…”

The Role of Anti-vascular Endothelial Growth Factor Agents in the Management of Retinopathy of Prematurity

“…81 Other retrospective reports have shown similar results. [82][83][84] Furthermore, a recent Cochrane meta-analysis that reported reduced myopia and retinal detachment with anti-VEGF agents, emphasized that the quality of evidence did not allow authors to fully rule out bias. The Cochrane review concluded that due to insufficient data and an unbeknownst systemic safety profile that strong conclusions could not be made favoring routine use of anti-VEGF agents.…”