Abstract
Purpose :
To compare outcomes of infants with treatment-warranted retinopathy of prematurity (TW-ROP) who received intravitreal bevacizumab (IVB) injections with delayed diode laser photocoagulation (DLP) compared to DLP alone. We hypothesized that initial treatment with IVB does not lead to worse developmental outcomes as compared to DLP alone.
Methods :
A retrospective review was performed of all infants who underwent treatment for ROP with 0.625 mg IVB or DLP at Wake Forest University from 2009 to 2018. Patient characteristics including gestational age, birth weight, stage and zone of ROP at time of treatment, systemic comorbidities, and other surgical procedures were recorded. When available, neurodevelopmental outcomes including Bayley-III scores in cognition, language, and motor skills were recorded.
Results :
160 eyes of 80 infants were reviewed; 41 eyes received IVB with delayed DLP and 108 eyes received DLP alone. Average birth weight was 0.64 kg in the IVB group and 0.71 kg in the DLP-only group (p=0.24), while gestational age was 24.5 weeks in the IVB group and 25.4 weeks in the DLP-only group (p=0.02). The average corrected age was 36.6 weeks at the time of primary IVB and 39.5 weeks at the time of primary DLP (p=0.01). Average stage and zone at the time of IVB treatment was 3.0 and 1.8, and 100% of infants had plus disease. Average stage and zone at the time of DLP treatment was 2.9 and 2.0, and 76% of infants had plus disease.
There were a similar number of medical comorbidities, additional unrelated surgical procedures requiring general anesthesia (61% of IVB and 63% of DLP-only), and ventilator-dependence (91% of IVB and 88% of DLP-only). Average corrected age at follow-up was 24.0 months for the IVB group and 27.8 months for the DLP-only group. Average Bayley-III scores (IVB vs DLP) were 81.7 vs 80.8 for cognitive (p=0.91), 76.0 vs 85.4 for language (p=0.23), and 79.0 vs 84.5 for motor (p=0.40). The percentage of infants with documented developmental delay was 77.8% in the IVB group and 83.3% in the DLP-only group (p=0.96).
Conclusions :
Multiple factors, including medical comorbidities, degree of prematurity, and low birth weight in premature infants have been shown to be associated with increased risk of developmental delay. In this study, the addition of IVB to DLP is not associated with an increased risk of developmental delay in infants with TW-ROP.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.