Neurodevelopmental Outcomes in Infants Treated for Retinopathy of Prematurity: bevacizumab versus laser

Abstract

Purpose : To compare neurodevelopmental outcomes at 18-24 months corrected age (CA) in preterm infants treated with monotherapy intravitreal bevacizumab injection (IVB 0.625mg) to those treated with laser ablation

Methods : We performed a retrospective chart review of all infants treated for retinopathy of prematurity (ROP) between April 2009 and June 2015. Infants who died before neurodevelopmental assessment, infants with major congenital anomalies, and those with no follow-up data available were excluded. Infants who were treated for compassionate reasons and who received both IVB and laser were also excluded. Baseline characteristics were extracted from patients’ charts and from the Canadian Neonatal Network and the Canadian Neonatal Follow-up Network databases. The primary outcome was moderate-severe neurodevelopmental impairment (NDI). Secondary neurodevelopmental outcomes included the presence or absence of cerebral palsy and hearing loss requiring amplification. Secondary ROP outcomes included structural, visual and refraction outcomes as defined by the ETROP at 24±6 months CA. Bayley Scales of Infant Development, Third Edition, clinical examination, and the Ages and Stages Questionnaire were used for the assessment of NDI. Descriptive statistics, Pearson Chi-square or Fisher exact test were used for categorical variables and Student t-test and ANOVA F-test were used for continuous variables. The odds ratio for moderate-severe NDI was calculated for IVB compared to laser-treated infants

Results : Sixty-four out of 88 treated infants met inclusion criteria (34 IVB and 30 laser). Table 1 shows neurodevelopmental outcomes by treatment group. Mean visual acuity was 0.46±0.36 and 0.43±0.44 for the IVB and laser groups, respectively (p=0.85). Mean spherical equivalent was -3.21±5.10 and -4.72±5.34 for the IVB and laser groups, respectively (p=0.27). All treated infants in both groups had favorable structural outcomes

Conclusions : Infants in this cohort had similar neurodevelopmental outcomes after treatment with bevacizumab compared to laser. The results of our study are particularly relevant in light of increasing use of anti-VEGF agents in the treatment of severe ROP

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Table 1: Neurodevelopmental Outcomes.
*using laser as reference value. **adjusted for gestational age, sex, sepsis, duration of exposure to O2 in days. OR = odds ratio, CI = confidence interval, AOR = adjusted odds ratio