Term infant brain MRI after ROP treatment by anti-VEGF injection versus laser therapy

Area of Science:

• Neonatal ophthalmology
• Pediatric neurology
• Medical imaging

Background:

• Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are used for retinopathy of prematurity (ROP).
• Concerns exist regarding potential white matter brain injury and neurodevelopmental impairments associated with anti-VEGF therapy in preterm infants.
• This study compares structural brain injury in very low birth weight infants with type 1 ROP treated with bevacizumab versus laser ablation.

Purpose of the Study:

• To investigate the association between anti-VEGF (bevacizumab) treatment for type 1 ROP and structural brain injury.
• To compare brain MRI findings in very low birth weight infants treated with bevacizumab versus laser ablation for type 1 ROP.
• To assess the severity of overall brain and white matter injury using the Kidokoro scoring system.

Main Methods:

• Retrospective review of very low birth weight infants (2006-2021) with type 1 ROP treated with laser or anti-VEGF therapy.
• Intravitreal bevacizumab used for specific ROP classifications or when laser was not feasible.
• Brain MRIs at term equivalent age were reviewed by a pediatric neuroradiologist and scored for injury severity.

Main Results:

• Fifty-two infants met inclusion criteria (35 laser, 17 bevacizumab).
• No statistically significant difference in moderate-to-severe brain injury scores (overall or white matter) between bevacizumab and laser groups.
• Adjusted analyses confirmed no difference in injury severity between treatment groups.

Conclusions:

• Treatment of type 1 ROP with bevacizumab (anti-VEGF) is not associated with increased severity of structural brain or white matter injury on term MRI compared to laser ablation.
• Findings suggest comparable safety profiles regarding brain structure between the two treatment modalities.
• Further research may explore long-term neurodevelopmental outcomes.