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Bradley S Gundlach, Artemiy Kokhanov, Marie Altendahl, Alison Chu, Monica Khitri, Irena Tsui; Retinopathy of Prematurity: A Longitudinal Prospective Study of Visual Outcomes in Premature Infants. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3256.
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© ARVO (1962-2015); The Authors (2016-present)
The development of anti-vascular endothelial growth factor (anti-VEGF) therapies has revolutionized the treatment of pediatric retinal disease including retinopathy of prematurity (ROP), however clinical data of long-term visual outcomes surrounding its use in these patients is incomplete. Here, we investigate long-term visual outcomes of infants screened for ROP in the anti-VEGF era.
We reviewed Stein Eye clinic charts of subjects born at UCLA Medical Centers and screened for ROP as neonates. Data collected included parameters at birth (e.g., gestational age (GA), birth weight (BW)), treatment modalities (e.g., laser, anti-VEGF), and visual outcomes (e.g., visual acuity, refraction, amblyopia, strabismus, poor structural outcomes). The most recent eye exam was used for each age group. Generalized estimating equations were used for analysis to account for inter-eye correlations. A final multivariate model was used, incorporating covariates significant at the univariate stage.
137 patients were included in the analysis, with average GA 28.03 ± 2.71 weeks and BW 1064.4 ± 368.9g; 66 (48.1%) were inborn, and 76 (55.45%) were male. 76 (55.45%) did not develop ROP, 39 (28.4%) had Type 2 ROP, and 22 (16.1%) had Type 1 ROP; 23 patients received primary laser treatment, while an additional 4 received primary anti-VEGF followed by delayed laser treatment. Strabismus was associated positively with poor structural outcomes (OR = 1.36, p=.023) and negatively to GA (OR=0.97, p=.017); primary laser compared to primary anti-VEGF followed by delayed laser was positively associated with amblyopia (OR=1.33, p=.002) while controlling for GA. Subgroup analysis for visual acuity was performed on 51 patients who were 4+ years old, with average age at last follow-up 6.04 ± 1.3 years and average refraction -0.08 ± 3.7D. Primary laser as compared to primary anti-VEGF followed by delayed laser was independently associated with worse visual acuity (OR=1.75, p<.0001). No treatment vs. primary anti-VEGF followed by delayed laser was also independently associated with worse VA (OR=1.34, p=0.009).
Primary anti-VEGF followed by delayed laser led to better visual outcomes than primary laser, independent of GA, BW, or underlying poor structural outcomes. This supports the concept that anti-VEGF treatment improves visual development in preterm neonates.
This is a 2021 ARVO Annual Meeting abstract.
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