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Bedside bilateral sequential intravitreal anti-VEGF injections for retinopathy of prematurity
Priya Bajgai1, Susree Satavisa2, Taraprasad Das3
1Vitreoretinal Services, Nepal Eye Institute, Kathmandu, Nepal.
Insights
Bedside bilateral sequential intravitreal injections for retinopathy of prematurity (ROP) are effective and safe when administered by trained specialists. While complications like cataracts are rare, they require careful management to preserve vision in infants.
Area of Science:
- Ophthalmology
- Neonatal care
- Medical interventions
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Timely intervention is crucial for managing ROP, but transferring critically ill infants can be challenging.
- Bedside intravitreal injections offer a potential solution for ROP management in infants unable to travel.
Purpose of the Study:
- To evaluate the efficacy and safety of bedside bilateral sequential intravitreal anti-VEGF injections for ROP.
- To assess ocular adverse events associated with this procedure.
- To determine the outcomes of ROP treatment using this method.
Main Methods:
- Retrospective interventional study of infants receiving bedside bilateral sequential intravitreal injections for ROP.
- Analysis of clinical history, injection details, indications, and ocular adverse events.
- Follow-up of at least one month for all included infants.
Main Results:
- 192 infants (384 eyes) were included over 9 years.
- 92.4% of infants showed ROP regression or regression.
- The main ocular complication was cataract (0.5%), with no endophthalmitis reported.
Conclusions:
- Bedside bilateral sequential intravitreal injections for ROP are effective and safe when performed by ROP-trained specialists.
- While complication rates are low, careful monitoring for issues like cataracts is necessary.
- This approach facilitates ROP management for infants who cannot be transferred to specialized units.
Purpose:
To evaluate the outcome and ocular adverse events of bedside bilateral sequential intravitreal anti-vascular endothelial growth factor injections for retinopathy of prematurity (ROP) (BBSIR).
Methods:
This retrospective interventional study included infants who received BBSIR with a follow-up of at least 1 month. Clinical history, intravitreal injection details, indications, intraoperative and postoperative ocular adverse events, and outcomes were analyzed.
Results:
The study cohort included 192 babies (384 eyes) spread over 9 years. The mean gestational age was 30.2 ± 2.6 weeks (28.8-34.1), and the birth weight was 1098.11 ± 271.65 g (650-2000). The indications for BBSIR were as follows: 73.4% (n = 141 infants) were too sick to transfer to an ophthalmic unit, 10.9% (n = 21 infants) due to the parents' inconvenience of traveling to the ophthalmic center, and 15. 6% (n = 30 infants) due to both reasons. The injections were given by an ROP specialist/ROP-trained ophthalmologist after due parental consent, considering each eye as a fresh eye with separate scrubbing and draping. Light from the head-worn indirect ophthalmoscope served as the source of illumination. The retinopathy was regressing/regressed in 92.4% of babies until the last follow-up. The major ocular complication was cataract in 2 eyes (0.5%). There was no incidence of endophthalmitis till last follow-up (median 5.7 months).
Conclusions:
As per this study, BBSIR was observed to be effective and safe if given by those fully trained in the management of ROP. Though the rate of complications like cataract is small, they can pose management challenges and impact vision in a growing child.
