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Rates, Timing, and Predictors of Retreatment Across Risk-Cohorts in Retinopathy of Prematurity: Intravitreal
Francisco Altamirano1, Melissa Yuan2, Celine Chaaya3
1From the Department of Ophthalmology (F.A., M.Y., S.H., J.H.J., R.A., I.S.M., C.W., E.G., D.K.V., R.G., N.A.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Retreatment for retinopathy of prematurity (ROP) was low, especially with intravitreal bevacizumab. Aggressive ROP and laser treatment were linked to earlier retreatment needs in premature infants.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a leading cause of vision impairment in premature infants.
- Treatment-warranted ROP (TW-ROP) requires timely intervention to prevent vision loss.
- Comparing laser photocoagulation and intravitreal bevacizumab for ROP retreatment is crucial.
Purpose of the Study:
- To analyze the rates, timing, and predictors of retreatment for ROP.
- To compare retreatment outcomes between primary laser and intravitreal bevacizumab treatments.
- To identify factors influencing the need for ROP retreatment.
Main Methods:
- A retrospective, consecutive, comparative clinical study.
- Included infants treated for TW-ROP with primary laser or intravitreal bevacizumab (2017-2023).
- Assessed retreatment within 90 days, categorized as early (≤30 days) or late (31-90 days).
Main Results:
- Overall retreatment rate was 18.2% (33/181 eyes), exclusively in micro/nano-premature infants (<27 weeks GA and/or <800g).
- Early retreatment (≤30 days) occurred in 8.8% of eyes, with significantly higher rates in the laser group (21.5%) vs. bevacizumab group (1.7%).
- Bevacizumab group showed lower odds of overall and early retreatment, and a later postmenstrual age at retreatment compared to the laser group.
Conclusions:
- Early retreatment for ROP is infrequent, particularly with intravitreal bevacizumab.
- Aggressive ROP is a predictor of earlier retreatment, indicating more severe disease.
- Bevacizumab is associated with reduced retreatment rates and delayed intervention needs compared to laser therapy.
Objective:
To characterize rates, timing, and predictors of retinopathy of prematurity (ROP) retreatment among infants treated with primary laser or intravitreal bevacizumab injection.
Design:
Retrospective consecutive, comparative clinical study.
Participants:
Infants who underwent initial treatment for treatment-warranted ROP (TW-ROP) with either intravitreal bevacizumab or laser photocoagulation between 2017 and 2023.
Methods:
Patients were stratified into two treatment groups: primary laser group vs primary bevacizumab group.
Main Outcome Measures:
Retreatment within the first 3 months (0-90 days) was assessed and classified as early (≤30 days) or late (31-90 days).
Results:
Two hundred and thirty eight eyes of 122 infants were treated for ROP; of those, 181 (76.1%) eyes of 93 (76.2%) patients were included. There were 116 (64.1%) eyes in the bevacizumab group, and 65 (35.9%) eyes in the laser group. Thirty-three (18.2%) eyes-all micro- or nano-premature (<27 weeks GA and/or <800 grams)-required retreatment for TW-ROP. Sixteen (8.8%) required early retreatment at a median postmenstrual age (PMA) of 40.4 weeks (IQR, 38.44-43.3). There were differences in the proportion of early retreated infants (21.5% for laser vs 1.7% for injection, P < .001). Seventeen (9.4%) eyes required late retreatment. The median PMA at late retreatment was 45.6 weeks (IQR, 43.7-47.4). Infants in the bevacizumab group had lower odds of retreatment within three months than those with laser (OR, 0.23; 95% CI, 0.06-0.82). Similarly, patients in the bevacizumab group had lower odds of requiring early retreatment compared to those with laser (OR, 0.08; 95% CI, 0.04-0.18). Within eyes with retreatment, infants in the bevacizumab group had a later PMA at retreatment than those in the laser group (B = 6.81; 95% CI: 4.68-8.93). AROP was associated with earlier PMA at retreatment (B = -7.72; 95% CI, -9.36 to -6.10).
Conclusion:
In this study, early retreatment was low (8.8%), with most eyes initially treated with laser (21.5%) rather than bevacizumab (1.7%). Aggressive ROP was associated with earlier retreatment, highlighting its role as a marker of more severe disease. Compared to laser, bevacizumab was associated with lower overall and early retreatment, and delayed need for additional intervention when necessary. All retreatments occurred in micro- or nano-premature infants, suggesting that medium-to-low risk infants may require less strict post-treatment monitoring.
