Abstract
Purpose :
Previous studies of retinopathy of prematurity treatment have showed a potential advantage of intravitreal bevacizumab (IVB) over laser photocoagulation due to a reduced prevalence of myopia and high myopia (> 5D myopia) in IVB-treated infants. However, the longitudinal patterns of refractive error development contributing to this difference have not been reported. This prospective cohort study compared longitudinal refractive error and visual acuity development during the first 3.5 years of life in children with severe ROP treated with IVB or laser.
Methods :
Preterm infants (BW<1000g, GA 23-27 weeks) with Type 1 ROP were enrolled: IVB Group (N=22); Laser Group (N=26). Cycloplegic retinoscopy was conducted from 0.2 years corrected age and every 0.5-1.0 years thereafter until 3.5 years. Refractive error development was estimated with spherical equivalent, magnitude of astigmatism, and anisometropia. A linear mixed effect model was used to estimate the rate of individual development for each parameter. The model provided comparisons within each group as well as between groups.
Results :
At the final visit, the prevalence of myopia was 82.7% in the laser group and 47.7% in the IVB group (P<0.05) with a final mean spherical equivalent refractive error of -8.0±5.8 D in the laser group vs -2.3±4.2 D in the IVB group (P<0.001). Longitudinal SEQ in both groups was best fit with a bilinear model (Figure 1). Before 1 year, the rate of SEQ change was -6.0D/YR in the laser group and -4.4D/YR in the IVB group (P<0.001). After 1 year, the slopes were not significantly different (laser: -0.3D/YR; IVB: 0.5D/YR; P=0.09). The magnitude of astigmatism increased significantly with age at a similar rate (0.19D/YR) in both groups. Anisometropia significantly increased with age in both groups but was lower in the IVB group (0.34D/YR) than in the laser group (0.55D/YR). Final visual acuity in both groups was 0.47 logMAR, equivalent to a Snellen acuity of 20/60.
Conclusions :
IVB-treated infants developed significantly less myopia than laser-treated infants, largely due to a slower rate of refractive change during the first year of life. In both groups, the magnitude of anisometropia and astigmatism increased with age. Visual acuity also improved in both groups with age.
This is a 2020 ARVO Annual Meeting abstract.