Bevacizumab with delayed laser offers good refractive outcomes in ROP

Researchers compared refractive outcomes of primary peripheral retinal photocoagulation (PRP) versus bevacizumab with delayed PRP in infants with posterior type 1 retinopathy of prematurity (ROP).

Study design

This retrospective review included infants who were treated at a tertiary referral center for type 1 ROP between 2006 and 2016. The primary treatment practice changed from PRP to combined intravitreal bevacizumab with supplemental delayed laser in early 2011; some patients received bevacizumab monotherapy. Cycloplegic refraction was performed between 2 and 4 years of age.

Outcomes

The final analysis comprised 34 eyes of 19 infants in the primary PRP group, and 40 eyes of 21 infants in the combination group. The mean spherical equivalent (SE) cycloplegic refraction was -7.4 D in the PRP group and -0.16 D in the combination group (P<0.001). There was no statistically significant difference in mean SE between the combination group and the 8 eyes of 4 infants who received bevacizumab monotherapy.

Limitations

A majority of infants who received primary bevacizumab (37 out of 46) completed examination under anesthesia and PRP after 60 weeks postmenstrual age. Many infants may be ready for discharge before 60 weeks, and treatment prior to discharge may be necessary to decrease the chance of loss to follow up.

Clinical significance

Premature infants with type 1 ROP appear to be less myopic after treatment with bevacizumab combined with delayed PRP compared with primary PRP.