Refraction Changes After The Use of Bevacizumab in The Treatment Of Patients With Prethreshold Retinopathy Of Prematurity

Abstract

Purpose: To evaluate the refractive status in patients with premature birth and variant stages of retinopathy of prematurity (ROP) at the age of 6, 18, 30, 36 months-old.

Methods: This longitudinal, prospective cohort study enrolled 41 preterm patients. Patients were divided into the following groups: ROP without the need of treatment; prethreshold ROP treated with intravitrteal injection of 0.625mg/0.025ml bevacizumab (Avastin) (IVB); prethreshold ROP treated with combined bevacizumab and peripheral diode laser (LIO); and stage 4A ROP treated with lens sparing vitrectomy (VT). Cycloplegic refraction, axial length (AXL), anterior chamber depth (ACD), and lens thickness were measured at the age of 6, 18, 30 and 36 months’ corrected age.

Results: In total, 79 eyes from 41 patients were included in the study. 8 eyes (10.1%) received observation only; 35 eyes (44.4%) required IVB; 28 eyes (35.4%) received IVB and LIO treatment; and 8 eyes (10.1%) received VT. The average follow-up duration was 23.8 months (11 to 41 months). The mean spherical equivalence (SE) were -1.87 diopter (D) (range -13.50D to 7.13D, N = 41); -3.37D (range -15.63D to 2.88D, N=44); -1.93D (range -14.75D to 7.50D, N=33); and -2.91D (range -8.75D to 0.38D, N=8) at 6, 18, 30 and 36 months old. Most patients developed with the rule (WTR) astigmatism. At age 15 months, 31 eyes (75%) had WTR astigmatsm, and the trend continued to 24 months, whereas 36 eyes (45.6%) developed WTR astigmatism. The mean AXL were 20.60mm (range 19.50 to 21.76, N = 33); 20.65mm (range 19.14 to 21.75, N=21); 21.4mm (range 19.85 to 23.1, N=22); and 22.48mm (range 21.79 to 23.04, N=4) at 6, 18, 30 and 36 months old. The AXL did not differ significantly between different ages in the 4 groups but the vitrectomized group tend to have a longer AXL during follow-up. The ACD and average lens thickness did not differ significantly between different ages in the 4 groups.

Conclusions: ROP patients developed relatively minimal refractive errors after receiving IVB. The vitrectomized eyes tend to have higher chances of developing high refractive errors. Most of the patients developed WTR type astigmatism in the four groups. The vitrectomized eyes tend to develop longer AXL during follow-up, but no statistically difference was found.

Keywords: 706 retinopathy of prematurity • 676 refraction • 757 visual development: infancy and childhood