Do Infants Need Further Treatment after Receiving a Single Injection of Bevacizumab for Severe Retinopathy of Prematurity?

Theme: Paediatric ophthalmology and strabismus
What: Paediatric ophthalmology and strabismus
Part of: Paediatrics III: Retinopathy of Prematurity - Pathophysiology and Best Evidence for Prevention and Treatment / Pédiatrie III: Rétinopathie du prématuré - Pathophysiologie et meilleures données probantes pour la prévention et le traitement
When: 6/2/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 A

Abstract

Purpose: To assess the rate of re-treatment after a single injection of intravitreal bevacizumab (IVB), indications and characteristics of infants requiring further treatment. 

Study design: Retrospective cohort chart review. 

Methods: A review was performed of all consecutive infants treated between 2010-2021. Included infants had a single injection of IVB and a minimum follow-up of 6 months. Primary outcome was indications and frequency of re-treatment. Secondary outcomes included structural, visual, and refractive outcomes at last follow up.   

Results: 127 infants (238 eyes) were included; 35 (28%) infants (67 eyes) received further treatment. The mean gestational age was 24.1±1.1 (range 22.9-26.6 weeks), birth weight was 589±123 (range 400-900 grams) and post-menstrual age (PMA) at re-treatment was 85.3±93.8 (median 63.9, IQR=50.9-75.8, range 36.6-545.1 weeks). 49 eyes (73%) of re-treatments originally had ROP in zone I and 27 eyes (40%) had AROP. Reactivation (7.1%) and progression or inadequate signs of regression (1.7%) were indications for re-treatment, all before 60 weeks PMA. Prophylactic laser treatment was performed for persistent avascular retina (15.5%), and other reasons (3.8%). Fifty-eight eyes were re-treated with laser photocoagulation, seven eyes received another injection of IVB, and two eyes of one patient received laser and scleral buckle.  

All re-treated eyes had favorable structural outcomes at a mean age of 4.5±2.4 (range 0.8-10.0 years). Favorable visual outcomes were achieved in 83% (44/53) of eyes with measurable visual acuity. Mean monocular visual acuity was 0.5 ± 0.36 (median 0.4, IQR= 0.2-0.7, range 0.1-1.4 logMAR, n=53/67 eyes). Mean refractive error was -5.1± 5.4 (median -3.75, IQR -0.25 to -10.0, range +1.38 to -16.5 D, n=65/67 eyes). Prevalence of emmetropia (>-1.0 to ≤1 D) was (29%), overall myopia was (65%); low myopia (≥1.0 to <5 D) was (19%), high myopia (≥5 to <8 D) was (14 %), and very high myopia (≥ 8.0 D) was (32%).  

Conclusion: In this cohort, the likelihood of re-treatment was higher in eyes with ROP in zone I or with AROP. Re-treatment for progression, failure of regression, or reactivation of acute disease was encountered in under 9% of all patients. Prophylactic laser treatment was performed in under 20% of infants. Routine laser treatment of all infants before NICU discharge may not be indicated when adequate follow up is possible. With up to 10 years of follow-up, no re-treated eye developed unfavorable structural outcome, and most eyes had favorable visual outcomes. The prevalence of myopia was high in these eyes.  

 

Presenter(s)

Presenting Author: Maram Isaac

Additional Author(s):

Kamiar Mireskandari, The Hospital for Sick Children, University of Toronto

Nasrin Najm Tehrani, The Hospital for Sick Children, University of Toronto

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