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Alexis Warren, Keith Warren, Kathleen Weatherstone; Bevacizumab (Avastin™) as a treatment alternative for threshold retinopathy of prematurity (ROP).. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):973.
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Threshold ROP has been treated with panretinal laser photocoagulation as the conventional therapy. New evidence suggests a role of VEGF in the development of ROP. Anti-VEGF therapy has been shown to be effective in the treatment of other VEGF related proliferative retinopathies. Accordingly, intravitreal anti-VEGF therapy may provide an effective treatment alternative. We evaluated infants with threshold disease that were treated with either of the two modalities to determine if anti-VEGF therapy (Bevacizumab) was as safe and effective as conventional treatment.
We performed a retrospective consecutive case review of 47 infants with threshold ROP that required intervention. The initial 25 infants were treated with standard panretinal laser photocoagulation, and the remaining 22 infants were treated with intravitreal anti-VEGF therapy. Outcomes evaluated include regression of disease, time to maturation, refractive error, strabismus, retreatment and progression to retinal detachment.
Demographics for both groups were similar. Mean birth weight was 687.6 grams for the lasered infants and 637.5 grams for the bevacizumab group. Gestational age was 24.96 weeks for the lasered infants and 25.07 weeks for the bevacizumab group. Of note, 7/25 (28%) infants in the laser group had refractive errors compared to only 2/22 (9.09%) in the bevacizumab group. This was statistically significant. In addition, time to maturation was 45.15 weeks for the lasered group, but was extended to 53.87 weeks for the bevacizumab group. Two infants in the bevacizumab group required strabismus surgery compared to one in the laser group. Two infants in the laser group required retreatment compared to one infant in the bevacizumab group. One infant in the laser group required vitrectomy.
Both treatment modalities appear to be effective in preventing the progression of ROP. Infants in the Anti-VEGF group had statistically fewer refractive errors but a higher incidence of strabismus. It appeared however, that infants undergoing Anti-VEGF therapy did require longer follow-up before reaching maturation. While there was a difference in the incidence of retreatment, strabismus and vitrectomy between groups, it was not significant. While Anti-VEGF therapy in this study appears to be a safe and effective modality for the treatment of threshold ROP, additional randomized clinical studies are indicated.
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