Skip to main content

  • One-Year Outcomes of Low-Dose Bevacizumab for ROP

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, October 2022

    Download PDF

    Intravitreal bevacizumab at low or very low doses has been described as an effective short-term treatment for type 1 retinopathy of prematurity (ROP). Freedman et al., for the Pedi­atric Eye Disease Investigator Group, described the one-year outcomes for small doses of bevacizumab to manage ROP, including reactivation rates and the need for more treatment. They found that low and very low doses re­sulted in good retinal struc­ture at one year—but that many eyes required further treatment. Reactivation of severe ROP tended to occur sooner if the bevacizumab dose was very low.

    This multicenter, masked, dose de-escalation study included infants who were born prematurely and were diagnosed as having type 1 ROP. Low-dose bevacizumab was defined as .25, .125, .063, or .031 mg. Very low-dose treatment was defined as .016, .008, .004, or .002 mg. Treatments were administered to the study eye. If the fellow eye also exhibited type 1 ROP, researchers administered a dose that was one level higher than that given to the study eye. After the initial treat­ment, continuation or modification of treatment was at the investigator’s discretion. Main outcome measures were reactivation of severe ROP by six months’ corrected age, need for additional treatment, health of ocular structures, and refractive error at 12 months’ corrected age.

    Altogether, 62 (55%) of 113 study eyes and 55 (56%) of 98 fellow eyes received additional treatment. In 31 (27%) of the study eyes, this consisted of further ROP therapy (six for failure of initial treatment, four for reactiva­tion within four weeks, and 21 for reactivation later). Thirty-one infants required prophylactic laser treatment for per­sistent avascular retina. The need for additional treatment was un­related to the ini­tial bevacizumab dose, but reacti­vation occurred earlier if the dose was very low (mean, 76.4 days vs. 85.7 days for a low dose). By 12 months, 3% of the study popu­lation had a poor retinal outcome, and 5% had an anterior segment abnormal­ity. Complications included macular ectopia and stage 5 retinal detachment. Optic atrophy was observed in 10% of the infants, and strabismus was present in 29%. The median refraction at 12 months’ corrected age was mildly myo­pic (–.31 D).

    These data are consistent with pre­viously reported rates of reactivation, said the authors. (For more on bevacizumab for ROP, see “A New Field Guide to ROP: ICROP-3.”)

    The original article can be found here.