Abstract
Purpose :
While anti-VEGF medications have become a critical component of the management of Aggressive Posterior Retinopathy of Prematurity (APROP), there remains scarce literature regarding the long-term ophthalmic and systemic outcomes. We performed a retrospective clinical study in which we reviewed both ophthalmologic and pediatric medical records to determine ocular and neurologic function following treatment with intravitreal bevacizumab for APROP.
Methods :
This study included 43 eyes of 22 premature infants diagnosed with APROP which were treated with one intravitreal injection of bevacizumab. The average gestational age was 24 weeks (range: 23-27 weeks), and the average birth weight was 625.18 grams. The gender distribution was 13 male and 9 female. Patient records were reviewed to identify the post-menstrual age at the time of injection, regression status, rescue therapy events, complications, final visual acuity, final refraction, neurologic diagnoses and events, and duration of follow up.
Results :
The average post-mentrual age at the time of intravitreal injection with bevacizumab was 35.59 weeks, and the average follow-up was 4.08 years (range: 1.85-7.36 years). 35 eyes subsequently received panretinal photocoagulation at an average post-menstrual age of 53.17 weeks. 100% of the eyes ultimately demonstrated regression; however, one eye required rescue therapy with a second treatment of panretinal photocoagulation. At last follow-up, 23 eyes were able to read Snellen visual acuity letters, with an average acuity of 20/53. Snellen testing of the remaining eyes was largely limited by developmental delays and age. 55% of refracted eyes were myopic, while 41% were hyperopic. 19 eyes developed additional ocular pathology, including strabismus, amblyopia, nystagmus, and cataracts. 13 infants eventually developed chronic neurologic impairment, mostly commonly developmental delay, however, 12 of these children sustained frank neurologic insult as a neonate.
Conclusions :
Extreme prematurity is associated with significant perinatal medical and ocular morbidity. The vast majority of infants who developed chronic neurologic disease were diagnosed with neurologic disease during the perinatal period. Intravitreal bevacizumab, often with adjuvant panretinal photocoagulation, led to regression in 100% of eyes, with nearly half of the eyes retaining functional vision.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.