Skip to main content

  • Low-Dose Bevacizumab for ROP: Update on Outcomes

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, December 2018

    Download PDF

    Although intravitreal bevacizumab continues to gain popularity for treat­ment of severe retinopathy of prema­turity (ROP), concerns remain regard­ing long-term sequelae. In an earlier publication, Wallace et al. reported short-term outcomes for 61 infants in a dose de-escalation study. The authors have updated their study. Although they observed good structural outcomes after low-dose bevacizumab treatment, many eyes needed further treatment.

    This masked multicenter study included 61 infants with type 1 ROP in at least 1 eye. If the ROP was bilateral at enrollment, the study eye was chosen randomly. Study eyes received intra­vitreal injections of bevacizumab at de-escalating doses (0.25 mg, 0.125 mg, 0.063 mg, or 0.031 mg). If necessary, fellow eyes received 1 dose level higher (0.625 mg, 0.25 mg, 0.125 mg, or 0.063 mg, respectively). After 4 weeks, the de­cision to use additional treatment was made at the investigator’s discretion. Main outcomes were early ROP recur­rence, late ROP recurrence, additional treatment, and structural findings.

    Of the 61 eyes, 25 (41%) had ad­ditional treatment: 3 for early failure (within 4 weeks), 11 for late recurrence of ROP (after 4 weeks), and 11 for persistent avascular retina. Retreatment for late recurrence or early failure occurred in 2 of the 11 eyes receiving 0.25 mg (18%), 4 of the 16 eyes receiving 0.125 mg (25%), 8 of the 24 eyes given 0.063 mg (33%), and none of the 10 eyes given 0.031 mg. By the 6-month corrected age, 56 of the 61 study eyes (92%) exhibited ROP regression and normal posterior poles. One eye developed stage 5 retinal detachment, and 4 pa­tients died of preexisting conditions.

    In this study, bevacizumab doses as low as 0.031 mg resulted in favorable outcomes. It has been estimated that the standard 0.625-mg dose for ROP may be 10,000 times that needed to neutralize intraocular vascular endo­thelial growth factor. Hence, it may be prudent to reduce the dosage as much as possible. (Also see related commen­tary by Andreas Stahl, MD, in the same issue.)

    The original article can be found here.