Outcomes of early versus deferred laser after intravitreal ranibizumab in aggressive posterior retinopathy of prematurity

Gangwe, Anil; Agrawal, Deepshikha; Gangrade, Aashish Kumar; Parchand, Swapnil; Agrawal, Deepanshu; Azad, Raj Vardhan

doi:10.4103/ijo.ijo_3016_20

Cited by 6 publications

(9 citation statements)

References 23 publications

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“…The fourth category consisted of four papers, including 480 eyes of 260 premature infants, reporting refractive outcomes of sequential [28,29,34] or combined laser and anti-VEGF treatments [35] (Table 1). [20] 175 infants / 350 eyes Primary anti-VEGF treatment had a significantly lower incidence of amblyopia but no significant difference in the rate of myopia compared to primary laser treatment.…”

Section: Resultsmentioning

confidence: 99%

Refractive outcomes in infants treated for retinopathy of prematurity

Heidary¹,

Gharebaghi²

2022

Med Hypothesis Discov Innov Optom

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Background: Infants treated for retinopathy of prematurity (ROP) can develop visually significant refractive error. However, the degree of refractive error may differ between laser treatment and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. We reviewed studies that investigated refractive error outcomes of treatment in premature infants with ROP. Methods: In this narrative review, a literature search was carried out in PubMed/MEDLINE from 01/01/2000 to 20/10/2022 without language restrictions, using the following keywords: “anti-VEGF,” “ROP” or “prematurity retinopathy,” and “laser.” We included comparative studies on refractive error outcomes of intravitreal anti-VEGF and laser treatments, a combination of both modalities simultaneously or sequentially, and two anti-VEGF agents. Results: The initial search yielded 164 records. We reviewed the titles and abstracts of the retrieved papers and the reference list of published systematic reviews and meta-analyses, meta-analyses, or reviews on our topic. Thirty-three records fulfilled our inclusion criteria, which included refractive outcomes in 4350 eyes of 2359 participants treated for ROP. Based on the reported refractive outcomes, we divided the studies into four categories: 1) those that revealed a higher rate of refractive error in the laser-treated eyes than in the anti-VEGF-treated eyes; 2) those that revealed no significant difference in refractive outcomes between the two treatment modalities; 3) those that revealed a higher rate of refractive error in the anti-VEGF-treated eyes or compared refractive outcomes between two anti-VEGF agents; and 4) those that reported refractive outcomes in the eyes that received combined simultaneous or sequential treatment with laser after initial anti-VEGF treatment. We also summarized the refractive outcomes of all included primary studies in each category. Conclusions: This study showed that the laser-treated eyes experienced more myopic shift. However, the refractive outcomes in premature infants of laser treatment, anti-VEGF treatment, and a combination of both modalities simultaneously or sequentially were often contradictory. This variability resulted from obvious differences in the sample size, different follow-up durations, or inhomogeneous study or treatment designs. Further well-designed prospective trials on refractive outcomes and the trend of changes in the refractive status over long-term follow-ups in the eyes treated with ROP are necessary to identify consensus results concerning real-world refractive outcomes of each treatment modality or simultaneous or sequential combination of both modalities, to suggest a safe and effective treatment option for eye care professionals.

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Section: Resultsmentioning

confidence: 99%

Refractive outcomes in infants treated for retinopathy of prematurity

Heidary¹,

Gharebaghi²

2022

Med Hypothesis Discov Innov Optom

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“…VEGF plays a critical role in retinal vascular growth. Some studies have shown that peripheral retinal vascularization and abnormal vascular patterns tend to increase after anti-VEGF treatment (21,22). Retinal vascularization was decreased in eyes treated with anti-VEGF, even though the vasculature could reach the farthest limit with time (16).…”

Section: Discussionmentioning

confidence: 99%

Retinopathy of prematurity risk predictors in peripheral avascular areas after intravitreal ranibizumab treatment: Vascular outgrowth speed analysis

Chen¹,

Xiong²,

Ruan³

et al. 2022

Preprint

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Objective To explore the predictors of risk for peripheral avascular areas (PAR) in retinopathy of prematurity (ROP) after intravitreal ranibizumab (IVR) monotherapy Methods This retrospective study included 64 infants (118 eyes) who developed type 1 ROP and received IVR between July 2019 and March 2021. Retinal vascular outgrowth speed (RVOS) was assessed by measuring the disc diameter (DD) 2 months post-IVR. Potential risk factors were examined and recorded. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to determine risk factors and predict PAR values. Results Mean RVOS was 0.9 ± 0.6 DD/month in all eyes 2 months post-IVR; RVOS in treated eyes was higher than in non-treated eyes. Completed retinal vascularization was detected in 69 (58.5%) eyes, persistent PAR in 49 eyes (41.5%). Univariate logistic regression analysis showed that gestational age at birth, postnatal age (PNA) at surgery, cumulative clock hours (CCH) of the ROP lesion, RVOS after IVR, and ROP severity were individually associated with PAR. Multiple logistic regression analysis revealed that RVOS, CCH of the ROP lesion, and PNA at the time of surgery were independent risk factors for PAR. The ROC curve showed that the cutoff value for RVOS was 0.672 DD/month (area under the curve, 0.8184). Conclusions IVR treatment accelerates RVOS; RVOS is inversely related to PAR. RVOS < 0.672 DD/month was a potential predictor of PAR. CCH of the ROP lesion and PNA during surgery were independent risk factors for PAR.

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“…In the study “Outcomes of early versus deferred laser after intravitreal Ranibizumab in aggressive posterior retinopathy of prematurity,” the authors present valuable data on response of APROP to IVR with laser performed after either 1 week or 6 weeks. [ 3 ] They found comparable anatomical outcomes after early or differed laser.…”

mentioning

confidence: 99%

“…Babies in the differed arm of this study required fewer laser spots, and those who were evaluated at 6 months also showed lesser refractive error as compared to babies who received early laser treatment. [ 3 ] During intrauterine development, vascular precursors migrate into the retina, with cessation of their development after premature birth. Use of anti-VEGF leads to regression of disease signs and allows vascular growth to progress up to the point where the precursors are formed.…”

mentioning

confidence: 99%