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  • Anti-VEGF for ROP: Impact on Developmental Outcomes for the Eye and Brain

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2019

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    Fan et al. looked at ocular and neuro­development outcomes for toddlers born prematurely who had received intravitreal injections of bevacizumab for type 1 retinopathy of prematurity (ROP). Their findings support the growing trend of using anti-VEGF drugs to manage ROP.

    This prospective case-controlled study was conducted from June 2014 to January 2019 at Chang Gung Memorial Hospital in Taiwan. The final analysis set included 148 patients (85 boys, 63 girls), grouped as follows: premature infants without ROP (group 0; n = 79), premature infants with ROP whose condition regressed spontaneously without treatment (group 1; n = 31), and premature infants with ROP who were treated with a single intravitreal injection of bevacizumab (group 2; n = 38).

    Patients in all three groups received follow-up, and their ocular devel­opmental and neurodevelopmental outcomes were compared when they were 1 to 3 years old. Ocular evalua­tion included cycloplegic refractom­etry, axial length, and Cardiff acuity. Neurodevelopment was assessed with the Bayley Scales of Infant and Toddler Development (third edition).

    The mean age at evaluation was 1.49 years. As expect­ed, gestational age (GA), birth weight, and Apgar scores were sig­nificantly higher in group 0. There were no signifi­cant differences between groups 1 and 2 in demographics or systemic risk factors, except for younger GA in group 2. Cylindri­cal power was significantly larger in groups 1 and 2 compared with group 0. Relative to group 0, the spherical equiv­alent in group 2 was significantly more myopic, and Cardiff acuity was much poorer. Groups 1 and 2 were compara­ble in refractive status, axial length, and Cardiff acuity.

    There were no meaningful differ­ences in neurodevelopment between any of the three groups (after adjust­ing for GA and systemic risk factors), including the risk of poor neurodevel­opmental outcomes.

    The researchers noted that two previous retrospective studies raised concerns about neurodevelopmental outcomes for infants with ROP treated with bevacizumab. Although this study demonstrated no such disadvantage, the authors acknowledged that their sample size may have been inadequate for detecting small but clinically signif­icant differences. (Also see related com­mentary by Susan M. Carden, MBBS, PhD, in the same issue.)

    The original article can be found here.