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Trevor Washburn, Rachel Weinstein, Jill Zaveri, Jack Cohen; Neonates receiving anti-VEGF injections for retinopathy of prematurity: a 5-year retrospective analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5533.
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Controversy exists regarding the efficacy and safety of agents that inhibit vascular endothelial growth factor (VEGF) when used used off-label to treat newborns with retinopathy of prematurity (ROP). We performed a retrospective analysis to better understand the long-term outcomes of intravitreal anti-VEGF therapy as a first line treatment of ROP in neonatal inpatients at Rush University Medical Center (RUMC) from 2010 to 2015.
Patients with ROP who received anti-VEGF treatment during their inpatient admission between 2010 and 2015 were collected in a database consisting of 30 eyes of 16 patients. A retrospective chart analysis was conducted to identify patients with subsequent pediatric eye examinations at RUMC. Each patient's vision, alignment, refraction, anterior segment and fundus examinations were reviewed. Additional data included the patients' developmental status and history of breast feeding.
Of 30 eyes receiving anti-VEGF medications, 9 were seen for pediatric follow-up or consultation at RUMC. All of these follow-up patients were females between 2 and 3 years old. Bevacizumab was administered in 5 eyes at varying doses. Ranibizumab was administered in 4 eyes at the half dose of 0.25 mg per 0.025 mL. Anterior segment findings were unremarkable in all patients with the exception of an anterior polar cataract deemed visually unremarkable. All eyes were able to fix and follow without evidence of amblyopia. Two patients were referred to the pediatric ophthalmologist for pseudostrabismus, but subsequent chart review demonstrated that all patients were orthophoric without evidence of strabismus. While cycloplegic refraction varied from -3.50D to +1.50D, no anisometropia greater than +1.00D was noted between eyes and none of the patients required glasses. All patients with follow-up were diagnosed with developmental delay; however, confounding perinatal and peripartum factors, such as IVH and intrauterine drug exposure, make it difficult to ascertain the cause of delay.
The results of our study align with current literature in demonstrating that anti-VEGF therapy can improve outcomes such as vision, strabismus, refraction, and fundoscopic findings in infants with ROP without substantial short-term morbidity. However, more information is needed regarding the long-term systemic and developmental effects of intravitreal anti-VEGF therapy in neonates.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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