Major Article
Treatment of type 1 retinopathy of prematurity with bevacizumab versus laser

Presented at the 40th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Palm Springs, California, April 2-6, 2014, at the 2014 Annual Meeting of the Association for Research in Vision and Ophthalmology, Orlando, Florida, May 4-8, and at the 2014 Annual Meeting of the Canadian Ophthalmological Society, Halifax, Nova Scotia, June 4-7.
https://doi.org/10.1016/j.jaapos.2015.01.009Get rights and content

Purpose

To compare structural outcomes, visual function, refraction, and frequency of follow-up for infants with type 1 retinopathy of prematurity in zone I or zone II posterior treated with intravitreal bevacizumab (IVB) versus laser.

Methods

The medical records of infants treated with IVB or laser photocoagulation at our institution from January 2009 to May 2013 were retrospectively reviewed. Only infants with a minimum of 6 months’ follow-up were included. Outcome measures were structural outcome, visual acuity, and spherical equivalent (SE) at corrected age of 1 year. The frequency of follow-up visits during 9 months after treatment was evaluated.

Results

A total of 23 eyes of 13 infants were treated with IVB and 22 eyes of 12 infants were treated with laser. There was no statistically significant difference in gestational age or birth weight between groups. None developed unfavorable structural outcome. Mean visual acuity was 0.99 ± 0.38 logMAR for the IVB group and 0.71 ± 0.36 logMAR for the laser group (P = 0.34; 95% CI, −0.52 to 0.19). Mean spherical equivalent was −3.57 ± 6.19 D for the IVB group and −6.39 ± 4.41 D for the laser group (P = 0.33; 95% CI, −7.19 to 2.49). In the IVB group, infants had an average of 16.00 ± 6.00 follow-up visits; in the laser group, 6.00 ± 3.00 (P < 0.0001).

Conclusions

Both treatments resulted in good structural outcome, and no difference in visual acuity or refraction. However, more frequent follow-up was observed in the IVB group.

Section snippets

Methods

The medical records of all infants treated for type 1 ROP from January 2009 until May 2013 at the Hospital for Sick Children, Toronto, were retrospectively reviewed. Approval of the Research Ethics Board of the Hospital for Sick Children was obtained. Infants treated with intravitreal injection of bevacizumab or with retinal laser photocoagulation using diode laser 810 (Iris Medical Instruments Inc, Mountain View, CA) for type 1 ROP in zone I or zone II posterior were included. Bevacizumab was

Results

A total of 23 eyes of 13 infants were treated with IVB and 22 eyes of 12 infants were treated with laser. Table 1 shows baseline characteristics of the two groups. There was no statistically significant difference between groups. Table 2 shows indications for treatment in each group. All eyes were treated for type 1 ROP.

In the IVB group, all eyes received a single injection of 0.625 mg. Ten infants were treated in both eyes and 3 in one eye only. At last follow-up, no infant developed

Discussion

Our study showed that treatment with either IVB or laser resulted in good response, with regression of neovascularization and favorable structural outcome. This is in keeping with the ETROP study, which reported 90.9% favorable structural outcome for type 1 ROP following laser ablation12 and the BEAT-ROP study which showed that bevacizumab is more effective in the treatment of stage 3 with plus disease ROP than laser.4 Significant treatment effect was shown for zone I but not zone II posterior.4

Literature Search

PubMed and MEDLINE (Ovid) were searched without date restriction for English-language results using a combination of medical subject headings (MeSH) and the following relevant keywords: retinopathy of prematurity, treatment, bevacizumab, laser photocoagulation, and follow-up.

Acknowledgments

The authors acknowledge Derek Stephens, biostatistician, clinical research services, the Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, for his help in data analysis

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    • Cited by (0)

    Brandan's Eye Research Foundation, Concord, Ontario, Canada, provided funding toward our department research fund.

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