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Intravitreal bevacizumab for retinopathy of prematurity: refractive error results
Björn C Harder1, Frank C Schlichtenbrede, Stefan von Baltz
1Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
Insights
Intravitreal bevacizumab injections for retinopathy of prematurity (ROP) resulted in less myopia and astigmatism compared to laser therapy. This treatment offers a promising alternative for managing ROP and its visual consequences.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Conventional treatment for threshold ROP includes retinal argon laser therapy.
- Intravitreal bevacizumab has emerged as an alternative therapeutic option for ROP.
Purpose of the Study:
- To evaluate and compare refractive errors in infants treated for threshold ROP with intravitreal bevacizumab versus conventional retinal laser therapy.
- To assess the long-term visual outcomes, specifically myopia and astigmatism, associated with each treatment modality.
Main Methods:
- Retrospective, nonrandomized, interventional comparative study design.
- Inclusion of infants with threshold ROP treated with a single intravitreal bevacizumab injection (study group) or retinal argon laser therapy (control group).
- Cycloplegic refractometry performed at follow-up to determine refractive error and astigmatism.
Main Results:
- The bevacizumab group showed significantly less myopic refractive error compared to the laser group (-1.04 vs -4.41 diopters, P=.02).
- Prevalence of moderate and high myopia was significantly lower in the bevacizumab group (17% vs 54%, P=.02; and 9% vs 42%, P=.01, respectively).
- Refractive astigmatism was also significantly lower in the bevacizumab group (-1.0 vs 1.82 diopters, P=.03), with laser therapy being associated with increased myopic refractive error and astigmatism.
Conclusions:
- A single intravitreal bevacizumab injection is associated with reduced myopization and astigmatism compared to conventional retinal laser coagulation for threshold ROP.
- Bevacizumab therapy appears to be a beneficial alternative for ROP treatment, potentially leading to better refractive outcomes.
- These findings suggest that intravitreal bevacizumab may help mitigate long-term visual complications in infants with ROP.
Purpose:
To evaluate refractive error in infants who underwent intravitreal bevacizumab injection for treatment of threshold retinopathy of prematurity (ROP).
Design:
Retrospective nonrandomized interventional comparative study.
Methods:
The study group included all infants who consecutively received a single intravitreal bevacizumab (0.375 mg or 0.625 mg) injection for therapy of threshold ROP in fundus zone I or zone II. The control group included infants who had previously undergone retinal argon laser therapy of ROP. The follow-up examination included refractometry under cycloplegic conditions.
Results:
The study group included 12 children (23 eyes; mean birth weight: 622 ± 153 g; gestational age: 25.2 ± 1.6 weeks) and the control group included 13 children (26 eyes; birth weight: 717 ± 197 g; gestational age: 25.3 ± 1.8 weeks). Both groups did not differ significantly in birth age and weight and follow-up. At the end of follow-up at 11.4 ± 2.3 months after birth, refractive error was less myopic in the study group than in the control group (-1.04 ± 4.24 diopters [median: 0 diopters] vs -4.41 ± 5.50 diopters [median: -5.50 diopters]; P = .02). Prevalence of moderate myopia (17% ± 8% vs 54% ± 10%; P = .02; OR: 0.18 [95% CI: 0.05, 0.68]) and high myopia (9% ± 6% vs 42% ± 10%; P = .01; OR: 0.13 [95% CI: 0.03, 0.67]) was significantly lower in the bevacizumab group. Refractive astigmatism was significantly lower in the study group (-1.0 ± 1.04 diopters vs 1.82 ± 1.41 diopters; P = .03). In multivariate analysis, myopic refractive error and astigmatism were significantly associated with laser therapy vs bevacizumab therapy (P = .04 and P = .02, respectively).
Conclusions:
In a 1-year follow-up, a single intravitreal bevacizumab injection as compared to conventional retinal laser coagulation was helpful for therapy of ROP and led to less myopization and less astigmatism.
