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Anterior segment ischemia after laser for retinopathy of prematurity previously treated with antivascular endothelial
Clara M Castillejo Becerra1, Sasha A Mansukhani1, Samantha D Sagaser2
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Insights
Infants with retinopathy of prematurity (ROP) receiving anti-VEGF injections before laser photocoagulation had a higher risk of vision-threatening anterior segment ischemia (ASI). Further research is needed to confirm this finding and explore risk reduction strategies.
Area of Science:
- Ophthalmology
- Neonatal Care
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Anti-VEGF therapy and laser photocoagulation are common treatments for ROP.
- Anterior segment ischemia (ASI) is a potential sight-threatening complication.
Purpose of the Study:
- To evaluate the risk of vision-threatening anterior segment ischemia (ASI) in infants with ROP treated with anti-VEGF followed by laser photocoagulation.
- To compare ASI prevalence between combined anti-VEGF and laser treatment versus laser alone.
Main Methods:
- Retrospective review of medical records of infants treated for threshold ROP at Mayo Clinic (2002-2018).
- Inclusion criteria: laser photocoagulation with or without prior anti-VEGF injections.
- Data collected included gestational age, birth weight, and incidence of ASI.
Main Results:
- A total of 241 eyes from 122 infants were analyzed.
- Four of 54 eyes (7.4%) treated with anti-VEGF prior to laser developed ASI, compared to 2 of 187 eyes (1.1%) treated with laser alone (P=0.008).
- Infants receiving combined therapy had significantly lower gestational age and birth weight.
Conclusions:
- The prevalence of vision-threatening ASI was higher in infants treated with anti-VEGF followed by laser compared to laser alone.
- Early gestational age at birth was associated with ASI development.
- Further investigation is needed to confirm findings and identify risk reduction strategies for ASI.
Purpose:
To assess the risk of vision-threatening anterior segment ischemia (ASI) among retinopathy of prematurity (ROP) patients treated with anti-VEGF followed by laser photocoagulation.
Methods:
The medical records of all infants treated for threshold ROP with laser photocoagulation with and without prior anti-VEGF injections from January 1, 2002, through December 2018 at Mayo Clinic were retrospectively reviewed for the prevalence of vision-threatening ASI.
Results:
A total of 241 eyes of 122 infants were included. Mean gestational age was 25.1 weeks (range, 22.9-28.7); mean birth weight was 687.6 g (range, 360-1310 g). Of the 54 eyes (27 patients) treated with anti-VEGF prior to laser, 4 developed ASI (including corneal edema, cataracts, and choroidal effusion) compared with 2 of the 187 eyes (95 patients) treated with laser therapy alone (P = 0.008). Infants receiving both anti-VEGF and laser had a younger gestational age at birth (24.5 vs 25.3 weeks; P < 0.001) and lower birth weight (591.4 g vs 715.0 g; P < 0.001) than those who received laser alone. In multivariate analysis, early gestational age at birth was associated with development of ASI (P = 0.03); the association with anti-VEGF treatment (P = 0.07) fell short of statistical significance.
Conclusions:
The prevalence of vision-threatening ASI was higher among infants treated with intravitreal anti-VEGF followed by laser compared to those treated with laser alone. Further investigation is warranted to confirm this finding and identify potential factors for decreasing the risk of ASI.
