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Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone
B Mueller1, D J Salchow1, E Waffenschmidt1
1Department of Ophthalmology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Insights
Intravitreal bevacizumab (IVB) offers faster regression for posterior retinopathy of prematurity (ROP) compared to laser photocoagulation. While visual outcomes are similar, IVB results in lower refractive error in posterior ROP cases.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Retinal Diseases
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Type I ROP, particularly posterior ROP, requires effective treatment to prevent severe visual consequences.
- Intravitreal bevacizumab (IVB) has emerged as an alternative to traditional laser photocoagulation for ROP treatment.
Purpose of the Study:
- To compare the efficacy and outcomes of intravitreal bevacizumab (IVB) versus laser photocoagulation in treating type I retinopathy of prematurity (ROP).
- To evaluate the speed of ROP regression and long-term refractive outcomes in infants treated with IVB or laser photocoagulation.
Main Methods:
- Retrospective evaluation of 54 very low birth weight infants with type I ROP treated between 2011 and 2015.
- Infants received either intravitreal bevacizumab (IVB) (n=37) or laser photocoagulation (n=17).
- Comparison of ROP regression rates, recurrence, complications, and spherical equivalent at 12 months.
Main Results:
- Intravitreal bevacizumab (IVB) resulted in significantly faster regression of active ROP in posterior ROP cases (9-15 days) compared to laser photocoagulation (28-63 days).
- No significant difference in regression was observed for peripheral zone II ROP.
- While overall spherical equivalents at 12 months were comparable between treatments in posterior ROP, IVB led to a significantly lower spherical equivalent in posterior ROP compared to peripheral zone II ROP.
Conclusions:
- Intravitreal bevacizumab (IVB) is more effective for rapid regression of active posterior ROP than laser photocoagulation.
- Laser photocoagulation was associated with complications like macular dragging and exudative retinal detachment.
- IVB treatment for posterior ROP results in lower refractive error compared to peripheral ROP, suggesting potential long-term refractive implications.
Aims:
To investigate the outcome of intravitreal bevacizumab (IVB) compared with laser photocoagulation in type I retinopathy of prematurity (ROP).
Methods:
Case records of 54 consecutive very low birth weight (VLBW) infants with type I ROP (posterior ROP, n=33; peripheral zone II, n=21) who were treated either with IVB (n=37) or laser photocoagulation (n=17) between 2011 and 2015 were retrospectively evaluated.
Results:
Patients with posterior ROP displayed significantly faster regression of active ROP within 12 days (range 9-15 days) if treated with IVB compared with laser photocoagulation, where active ROP regressed within 57 days (range 28-63 days) (p>0.001). No difference was observed in peripheral zone II.Five of seven patients (12%) who developed a recurrence in both eyes after IVB required additional laser photocoagulation within a mean of 12.7 weeks (11.3-15.6 weeks) after the previous treatment. After laser photocoagulation one patient with posterior ROP developed macular dragging and another patient developed a temporary exudative retinal detachment in both eyes. 12 months after treatment the spherical equivalent was not statistically significant different between IVB and laser photocoagulation in posterior ROP patients. However, IVB lead to a significant lower spherical equivalent in infants with posterior ROP (+0.37 dioptres, range -0.5 to +1.88 dioptres) compared with peripheral zone II (+3.0 dioptres range +2.0 to +4.0 dioptres, p<0.001).
Conclusions:
IVB leads to faster regression of active ROP in infants with posterior ROP compared with laser photocoagulation. Spherical equivalent after 12 months was comparable in those treated with IVB and laser photocoagulation, but it was significantly lower in posterior ROP than in peripheral zone II.
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