• Pediatric Ophth/Strabismus, Refractive Mgmt/Intervention

    Review of: Longitudinal changes in refractive error in ROP treatment with intravitreal bevacizumab or laser photocoagulation

    Wiecek E, Akula J, Vanderveen D, et al. American Journal of Ophthalmology, August 2022

    This study compared progression of refractive error in children with retinopathy of prematurity (ROP) treated with either intravitreal bevacizumab (IVB), laser therapy, or IVB with subsequent laser.

    Study design

    This retrospective cohort study included 88 infants with type 1 ROP evaluated from April 2011 to November 2020 at a single US urban children's hospital. Twenty-two patients (40 eyes) were treated with IVB only, 48 (90 eyes) were treated with laser only, and 18 (36 eyes) were treated with IVB with subsequent laser. Follow-up lasted for >8.5 years. Two models were used for analysis: (1) a linear mixed-effects model to evaluate how the spherical equivalent and visual acuity changed with postmenstrual age; and (2) a more detailed model with additional parameters for ROP severity around ROP zone, stage, and clock-hours of the affected retina.

    Outcomes

    There was a significant trend in greater and more rapid myopic progression in the patients who received laser treatment, regardless of whether it was preceded by IVB; the rate of progression was 0.16 D per log-year for every 100 laser spots. In addition, the more severe the ROP (per zone and stage), the more significant and faster the myopic progression. A −0.63 D increase in myopic progression per log-year was seen with Zone I ROP compared with Zone II ROP, and for ROP stages 3 and 4 predicted myopic progression was −1.41 D per log-year faster than for ROP stages 1 and 2.

    Limitations

    This was a retrospective study conducted at one institution. In addition, no biometry measurements such as axial length, corneal steepness, or lens thickness were taken. Future studies of infants with ROP should include biometric analysis.

    Clinical significance

    This is the first study to report a significant myopic progression in children with ROP treated with laser therapy for >8.5 years. Other studies have not reported such a fast progression at a younger age. Treatment with IVB alone did not affect myopic progression. Ophthalmologists treating infants with severe ROP should be aware of the impact of laser treatment, with or without IVB, on myopic progression and the potential development of amblyopia.