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A Comparison of Respiratory Outcomes after Treating Retinopathy of Prematurity with Laser Photocoagulation or
Gerard P Barry1, Kate A Tauber2, Scott Greenberg3
1Department of Ophthalmology, Albany Medical College, Albany, New York; Department of Pediatrics, Albany Medical College, Albany, New York.
Insights
Infants receiving intravitreal bevacizumab for retinopathy of prematurity (ROP) recovered respiratory function faster than those treated with laser therapy under general anesthesia. This difference in respiratory outcomes persisted for at least seven days post-treatment.
Area of Science:
- Neonatal ophthalmology
- Pediatric critical care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Treatment decisions for ROP involve balancing ocular outcomes with potential systemic effects, particularly on respiratory status.
- Laser therapy under general anesthesia and intravitreal bevacizumab under sedation are common treatment modalities.
Purpose of the Study:
- To compare respiratory outcomes between infants treated for ROP with laser therapy under general anesthesia and those treated with intravitreal bevacizumab under bedside sedation.
- To evaluate the rate of return to preprocedure respiratory baseline following each treatment modality.
Main Methods:
- Retrospective cohort study of 138 infants treated for ROP.
- Data collected included respiratory status at multiple time points (24 hours, 48 hours, 7 days, 28 days) post-treatment.
- Multivariate logistic regression analysis was used to compare respiratory outcomes, controlling for confounding factors.
Main Results:
- Infants treated with intravitreal bevacizumab returned to respiratory baseline significantly faster than those treated with laser therapy.
- At 48 hours post-treatment, 79% of bevacizumab-treated infants had returned to baseline versus 53% of laser-treated infants (P=0.0453).
- Laser-treated infants were less likely to return to respiratory baseline at 48 hours (OR, 0.14; 95% CI, 0.04-0.54).
Conclusions:
- Intravitreal bevacizumab with bedside sedation offers a faster return to respiratory baseline compared to laser therapy under general anesthesia for ROP treatment.
- The observed respiratory benefits of bevacizumab persisted for at least seven days post-procedure.
- These findings suggest that the choice of ROP treatment modality can impact short-term respiratory recovery in premature infants.
Purpose:
To compare respiratory outcomes after treatment of retinopathy of prematurity (ROP) between infants treated with laser therapy under general anesthesia and infants treated with intravitreal bevacizumab under bedside sedation.
Design:
Retrospective cohort study.
Participants:
One hundred thirty-eight consecutive infants treated for ROP from September 2010 through September 2018 at 1 institution.
Methods:
Retrospective medical, procedural, and ophthalmologic data were collected, including preprocedure (baseline) and postprocedure (24 hours, 48 hours, 7 days, and 28 days) respiratory status, birth weight, gestational age, gender, ROP treatment method, postmenstrual age at treatment, and coincident nonocular procedures during anesthesia. Respiratory outcomes at 48 hours were compared between infants treated with laser therapy under general anesthesia and infants treated with intravitreal bevacizumab under local sedation using multivariate logistic regression analysis to control for potentially confounding factors.
Main Outcome Measures:
Proportion of infants who had returned to their respiratory baseline by 48 hours after ROP treatment.
Results:
Return to respiratory baseline was significantly less common among 119 infants initially treated with laser therapy compared with 19 infants initially treated with bevacizumab at 24 hours (40% vs. 74%; P = 0.0115), 48 hours (53% vs. 79%; P = 0.0453), and 7 days (79% vs. 100%; P = 0.0242). In a multivariate logistic regression analysis, infants treated with laser therapy were less likely to return to respiratory baseline at 48 hours (odds ratio, 0.14; 95% confidence interval, 0.04-0.54). At 28 days, no difference was found between groups (laser, 97%; bevacizumab, 100%; P > 0.99).
Conclusions:
Infants treated with intravitreal bevacizumab using bedside sedation returned to their preprocedure respiratory baseline faster than infants treated with laser under general anesthesia, with the differences persisting at least to 7 days or more after the procedure.
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