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Pankaj Malhotra, Kamal Kishore; Long-Term Safety and Efficacy of Intravitreal Bevacizumab (IVB) for Aggressive Posterior Retinopathy of Prematurity (AP-ROP). Invest. Ophthalmol. Vis. Sci. 2014;55(13):5900.
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To evaluate the long-term safety and efficacy of IVB for the treatment of APROP.
We conducted a retrospective chart review of 28 eyes of 15 consecutive premature infants with AP-ROP treated with 0.625 mg/0.025 mL IVB at a single institution from May 2010 through September 2012 by three retina specialists. Only infants with at least six months follow-up (FU) were included for further analysis. Injection was administered in the inferonasal (IN) quadrant 2 mm behind the limbus in 11 eyes, and 1 mm behind the limbus in the inferotemporal (IT) quadrant in 17 eyes. We studied complications of injections and late retinal detachments (RD), and sought to investigate predictive factors for RD with regard to gestational age (GA), chronological age (CA), birth weight (BW), postmenstrual age (PMA) at treatment, injection site, and stage of ROP. We also reviewed surgical interventions, including laser, vitrectomy and cataract surgery following initial IVB injection.
PMA, GA, CA, BW and stage of ROP were not statistically significant between the RD and No RD groups (Table). Two eyes developed cataract and needed cataract surgery (both IN group). RD was diagnosed in 7 eyes (25%, 95% CI 12.7-43.4%, all in IN group) of 4 patients. Mean+/-SD PMA at diagnosis of RD was 61.5+/-14.47 (range 47-82) weeks, and RD was diagnosed after a mean of 25.5+/-14.1 (range 9.5-45) weeks after IVB. Four of 21 (19%, 95% CI 7.6-40%) eyes in No RD group received supplemental laser 4-9 weeks following IVB due to reactivation of ROP. In RD group, surgical repair was performed on 5 eyes, with successful anatomical reattachment in 4. Injection 2 mm in IN quadrant was more likely to result in RD (64%, 95% CI 35.4-84.8% v 0%, p=0.003 Fisher Exact test). No eye received repeat IVB.
We encountered considerably higher incidence of complications compared to those reported in the BEAT-ROP study. Posterior injection site in IN location was associated with increased risk of RD. Most RDs occurred after 54 weeks, the cutoff for follow-up in BEAT-ROP.
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