Refractive outcomes comparing primary laser to primary bevacizumab with delayed laser for type 1 ROP

Abstract

Purpose: To compare the refractive outcomes of intravitreal bevacizumab (IVB) and delayed peripheral retinal photocoagulation (PRP) with primary PRP in infants treated for posterior type 1 ROP.

Methods: The medical records of 87 infants at a tertiary referral center treated for posterior type 1 ROP between 2006 and 2016 were reviewed retrospectively. Consecutive infants received primary PRP before and primary IVB after a change in treatment practice implemented in early 2011. In most cases primary IVB was supplemented with prophylactic laser treatment after 60 weeks' PMA (IVB-PRP). The main outcome was spherical equivalent (SE) in diopters, determined by cycloplegic refraction between 2 and 4 years. Infants treated with IVB-PRP were also compared to the those who received only IVB as monotherapy.

Results: The final analysis included 34 eyes of 19 infants in the primary PRP group and 40 eyes of 21 infants in the IVB-PRP group. Mean SE was -7.4 ± 5.2 D in the primary PRP group and -0.16 ± 2.2 D in the IVB-PRP group (P < 0.001). This relationship persisted after stratification by zone of ROP and the presence of aggressive posterior ROP. There was no statistically significant difference in mean SE between the IVB-PRP group and the 8 eyes of 4 infants who received IVB as monotherapy. Of 46 infants who received primary IVB, 37 completed an examination under anesthesia after 60 weeks' PMA. In these patients, 70% of eyes showed peripheral vascular leakage on fluorescein angiography.

Conclusions: In our study cohort, infants treated with IVB-PRP were significantly less myopic than those treated with primary PRP. Delayed laser after 60 weeks' PMA, in hopes of reducing the risk of late reactivation with retinal detachment, did not negate the refractive benefits of primary IVB.