Vascular abnormalities common following intravitreal bevacizumab for ROP

Researchers report the regression patterns experienced by patients after off-label intravitreal bevacizumab therapy for retinopathy of prematurity (ROP).

Study design

This retrospective cohort study included 46 patients (92 eyes) with ROP who were treated with bevacizumab at a single institution over a 5-year period. Three eyes were excluded because they reached complete vascular maturity at 60 weeks.

Outcomes

The remaining 89 eyes had some degree of vascular abnormality including vascular arrest alone (43.8%), vascular arrest with persistent tortuosity (38.2%) and ROP reactivation (18%). There was a significant difference in gestational age between the 3 cohorts; patients with ROP reactivation were the most premature and were born, on average, at 24.4 weeks.  All abnormalities, however, were observed in babies who had an average gestational age between 24 and 25 weeks.

Eyes with reactivated ROP were also more likely to have been initially diagnosed with aggressive posterior ROP (P=0.004) and be of Asian ethnicity (P=0.008). Younger birth age was an independent marker of persistent tortuosity.

Limitations

Since this study is from 1 institution, there may be differences in racial makeup, socioeconomic factors and institution-specific characteristics that may have influenced the outcomes.

Clinical significance

Although intravitreal bevacizumab remains important for the treatment of some forms of ROP, the disease course following anti-VEGF therapy is different than pan retinal laser photocoagulation. These children need regular follow-up over an extended period of time to monitor and possibly treat late-term reactivation and sequelae.