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Bilateral Anti-VEGF on Same-Day-Investigation on Safety in Retinopathy of Prematurity: A Multicenter Retrospective
Anil Babanrao Gangwe1, Anjali Agrawal1, Subhadra Jalali2
1MGM Eye Institute, Raipur, Chhattisgarh, India.
Insights
Bilateral same-day intravitreal anti-VEGF injections for retinopathy of prematurity (ROP) in infants show a low incidence of complications, with presumed endophthalmitis occurring in 0.07%. Extra precautions are advised for procedures in the NICU or by less experienced ophthalmologists.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- Intravitreal anti-VEGF injections are increasingly used for ROP treatment.
- Bilateral, same-day injections aim for treatment efficiency but require safety evaluation.
Purpose of the Study:
- To determine the incidence of procedure-related complications in preterm infants undergoing bilateral, same-day intravitreal anti-VEGF injections for ROP.
- To identify factors associated with these complications.
Main Methods:
- Retrospective, multicenter case series analysis of preterm infants with ROP.
- Data collected on intravitreal anti-VEGF injections in both eyes on the same day.
- Postoperative examination to identify complications such as endophthalmitis, lens injury, and retinal tears.
Main Results:
- A total of 9,984 eyes from 4,992 infants were analyzed.
- Overall complication rate was 0.3%, with lens injury (0.15%) and presumed endophthalmitis (0.07%) being most common.
- Lens injury risk increased in the NICU setting and with less experienced operators; endophthalmitis risk was not associated with setting or anti-VEGF type.
Conclusions:
- Bilateral, same-day intravitreal anti-VEGF injections for ROP are associated with a low incidence of presumed endophthalmitis (0.07%).
- The procedure is generally safe with appropriate technique (needle parallel to visual axis).
- Increased vigilance is recommended for NICU procedures and those performed by ophthalmologists with limited experience.
Purpose:
To report an incidence of procedure-related complications in preterm infants with retinopathy of prematurity (ROP) treated with intravitreal anti-VEGFs injection in both eyes on the same day.
Design:
Retrospective, multicenter case series.
Subjects:
Preterm infants with ROP treated with anti-VEGF bilaterally on the same day.
Methods:
All included infants underwent intravitreal anti-VEGF injection in both eyes under aseptic precautions in an ophthalmic operation theater (OT) or neonatal intensive care unit (NICU). A postoperative examination was performed to look for procedure-related complications.
Main Outcome Measures:
Incidence of procedure-related complication (presumed endophthalmitis, intraocular inflammation, lens injury, vitreous hemorrhage, and retinal tear) in the study cohort. To study the association of indication, type of anti-VEGF, type of needle used, setting of procedure, site of injection (distance from limbus), and experience of the treating ophthalmologist with the complications.
Results:
Nine thousand nine hundred and eighty-four eyes of 4992 infants were analyzed. The procedure was most commonly performed in ophthalmic OT (8258, 82.7%) using a 29G (4514, 45.2%) needle between 1 and 1.5 mm (9984, 100%) from limbus. Aggressive ROP was the most common indication for anti-VEGF use (4866, 48.7%), whereas Bevacizumab was the most commonly used anti-VEGF agent (8642, 86.6%). Overall, 26 eyes (0.3%) had procedure-related complications. Lens injury (15, 0.15%) and presumed endophthalmitis (7, 0.07%) were the most common complications. One eye had culture-proven endophthalmitis with Pseudomonas aeruginosa. No case of bilateral endophthalmitis was noted. Endophthalmitis was not associated with the setting of a procedure or type of anti-VEGF used, whereas the risk of lens injury was 7 times higher when performed in NICU and 30 times higher when performed by an ophthalmologist with <1 year of experience in injecting anti-VEGF in preterm infants.
Conclusions:
The incidence of presumed endophthalmitis after bilateral same-day anti-VEGF in infants with ROP is 0.07%. These infants can be treated in both eyes on the same day with the anti-VEGFs and needles (29-32G) evaluated in this study, with emphasis on the direction of needle parallel to the visual axis. Extra precaution is advocated if the procedure is planned in the NICU or by an ophthalmologist with limited experience.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
