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Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated With Intravitreal Bevacizumab or Laser
Emily Wiecek1, James D Akula1, Deborah K Vanderveen1
1From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA.
Insights
Laser treatment for retinopathy of prematurity (ROP) accelerates myopia progression in infants. Intravitreal bevacizumab (IVB) did not impact myopia but reduced laser treatment needs, though laser
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Retinopathy of Prematurity Research
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Myopia progression is a known complication following ROP treatment.
- Intravitreal bevacizumab (IVB) and laser photocoagulation are common ROP treatments with differing impacts on refractive error.
Purpose of the Study:
- To compare the longitudinal progression of myopia and refractive error in premature infants with ROP treated with intravitreal bevacizumab (IVB) versus laser photocoagulation.
- To analyze the long-term refractive outcomes in a cohort of infants treated for ROP.
Main Methods:
- Retrospective clinical cohort study design.
- Inclusion of premature infants with ROP treated with IVB or laser between 2011 and 2020.
- Longitudinal cycloplegic refraction data analyzed using a linear mixed-effects model with a log decay function over a median of 3.2 years.
Main Results:
- A significant trend towards myopia was observed in aggregate, progressing from slight hyperopia to more myopic states (P < .001).
- Laser-treated eyes showed significantly more rapid myopic progression (P < .001).
- Myopic progression was associated with the number of laser spots (0.16 D per 100 spots) and severity of ROP (stage and zone).
Conclusions:
- Laser treatment for severe ROP is a significant risk factor for increased myopic progression.
- Intravitreal bevacizumab (IVB) did not influence myopic progression but reduced the need for subsequent laser treatment.
- The myopiagenic effect of laser treatment persists even after accounting for ROP severity.
Purpose:
To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser.
Design:
Retrospective clinical cohort study.
Methods:
We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment.
Results:
In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment.
Conclusions:
Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.
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