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Rebecca Deutsch, Hreem Patel, Kevin Ferenchak, Jack A Cohen; Comparing Outcomes and Complication Rates with Intravitreal Bevacizumab versus Laser Therapy for Type 1 Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5914.
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To compare the treatment outcomes and complication rates of intravitreal bevacizumab as monotherapy vs. laser therapy for Type 1 retinopathy of prematurity (ROP).
A retrospective review of 16 patients, 8 receiving intravitreal bevacizumab (IVB) and 8 receiving laser therapy at Rush University Medical Center from 2007 to 2013 with Type 1 ROP. Gestational age, birth weight, sex, stage and zone of ROP, presence of plus disease, age at treatment, initial response to treatment, time until stabilization, and final outcome were collected. One surgeon performed laser therapy or injected 0.625mg of IVB for each of the patients reviewed.
16 eyes of 8 patients were treated with IVB and 15 eyes of 8 patients were treated with laser therapy. All eyes had Type 1 ROP. Mean gestational age for the patients treated with IVB was 25.0 weeks (24.0-27.0) vs. 25.4 weeks (23.1-27.9) for patients treated with laser therapy. Mean birth weight for patients treated with IVB was 650g (430g-900g) vs. 705g (440g-1349g) for patients treated with laser therapy. The adjusted mean gestational age at treatment in IVB patients was 37.2 vs. 36.5 weeks for laser therapy patients. Response time for treatment in 2 weeks with IVB was demonstrated in 87.5% of patients vs. 73.3% of patients with laser therapy. Time until stabilization for patients treated with IVB was 27.1 days (7-112 d) vs. 31 days (13-63 days) for patients treated with laser therapy. ROP regressed in 88% of IVB patients vs. 80.0% of laser treated patients. One complication was seen in patients receiving IVB therapy: a vitreous hemorrhage in one eye. Patients treated with laser therapy had complications including severe myopic astigmatism, anisometropic amblyopia, peripheral chorioretinal atrophy, macular dragging, and temporal traction requiring vitrectomy. No systemic complications were seen in either treatment group.
Laser therapy for ROP is the current gold standard, however the rate of ocular complications is high compared to IVB. The final outcomes are similar in our study. Given the number of complications from laser therapy, IVB should be considered as a first line therapy for ROP. More information is needed about the long term ocular and systemic complications of IVB. Further investigation is warranted to evaluate the role of IVB as monotherapy for the primary treatment of ROP.
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