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Refractive outcomes comparing primary laser to primary bevacizumab with delayed laser for type 1 ROP

Nandita Anand1, Michael P Blair2, Mark J Greenwald1

  • 1University of Chicago, Department of Ophthalmology and Visual Science, Chicago, Illinois.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|February 25, 2019
PubMed

Insights

Intravitreal bevacizumab (IVB) with delayed laser (IVB-PRP) resulted in significantly less myopia in infants with retinopathy of prematurity (ROP) compared to primary laser treatment. This refractive benefit was maintained even with delayed laser application.

Area of Science:

  • Ophthalmology
  • Neonatology
  • Retinal Diseases

Background:

  • Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
  • Posterior type 1 ROP requires prompt treatment to prevent severe visual impairment.
  • Current treatment options include laser photocoagulation and anti-VEGF therapy.

Purpose of the Study:

  • To compare refractive outcomes between primary peripheral retinal photocoagulation (PRP) and intravitreal bevacizumab (IVB) with delayed PRP in infants with posterior type 1 ROP.
  • To evaluate the long-term refractive status (spherical equivalent) of treated infants.

Main Methods:

  • Retrospective review of 87 infants treated for posterior type 1 ROP between 2006 and 2016.
  • Comparison of primary PRP group with IVB-PRP group (IVB supplemented with prophylactic laser).
  • Cycloplegic refraction measured between 2 and 4 years of age.

Main Results:

  • The IVB-PRP group showed significantly less myopia (mean SE -0.16 D) compared to the primary PRP group (mean SE -7.4 D).
  • This difference remained significant across different ROP zones and severity.
  • No significant difference in refractive outcomes was observed between IVB-PRP and IVB monotherapy.

Conclusions:

  • Intravitreal bevacizumab with delayed laser photocoagulation leads to better refractive outcomes in infants with posterior type 1 ROP.
  • Delayed laser treatment did not diminish the refractive advantages of initial IVB therapy.
  • IVB-PRP represents a promising alternative for managing posterior type 1 ROP with reduced myopia.
Abstract

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