Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated with Bevacizumab or Laser Photocoagulation

Abstract

Purpose : Myopia is the most common clinical sequela of preterm birth and is especially common following retinopathy of prematurity (ROP). However, reported rates of myopia are lower in children whose ROP was treated with anti-vascular endothelial growth factor (anti-VEGF) agents as compared to conventional laser photoablation. We examined the progression of refractive error, over a period of up to nine years, in preterm-born children with ROP treated with either injection of the anti-VEGF agent Bevacizumab or laser.

Methods : We performed a retrospective review of records of premature infants treated for ROP at Boston Children’s Hospital from 2011-2020 with Bevacizumab (n = 24) or laser (n = 54). Bevacizumab dosage ranged from 0.02mg- 0.75mg. We analyzed cycloplegic refractions from 349 cumulative visits (mean 4±3 visits per individual; mean 2.3±2.7 years under observation), using a linear mixed effects model, to evaluate how refraction changed with corrected age following treatment.

Results : In aggregate, the model estimated a significant (P < 0.001) trend in refraction, from slight hyperopia to relatively more myopic states, as is common in emetropization. However, the progression in laser-treated eyes was significantly (P = 0.002) more rapid: The estimated progression in individuals treated with laser was -0.79 diopters per year compared to only -0.02 diopters per year in eyes treated with Bevacizumab. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 70% of the remaining variance not explained by corrected age and treatment.

Conclusions : Our analysis suggests that children with ROP who are treated with laser photocoagulation will tend to progress to myopia at a higher rate compared to those individuals treated with Bevacizumab.

This is a 2021 ARVO Annual Meeting abstract.