Early Refractive Outcome After Intravitreous Bevacizumab for Retinopathy of Prematurity FREE

Retinopathy of prematurity (ROP) is a neovascular retinal disease that has usually been treated by peripheral argon laser coagulation. Retinal laser coagulation has disadvantages and adverse effects such as the need for general anesthesia, scarring of the peripheral retina and choroid, and presumably induction of myopization.^1- 2 Based on the role of vascular endothelial growth factor in retinal neovascularization, recent studies have shown the therapeutic effect of intravitreous bevacizumab as a vascular endothelial growth factor inhibitor for the therapy of ROP.^3- 4 Besides the short-term effects of this anti–vascular endothelial growth factor therapy in terms of a regression of retinal neovascularization, effects of the therapy on the development of myopia have not yet been examined. We therefore assessed the refractive error of children who had received intravitreous bevacizumab for therapy of ROP.

The prospective study included all children who had been treated with an intravitreous injection of bevacizumab (0.375 mg; Avastin) for ROP threshold disease in posterior zone 2 or zone 1 or for prethreshold ROP in zone 1. Diagnosis was based on the guidelines of the International Committee for the Classification of Retinopathy of Prematurity.⁵ The study group was compared with a control group that had previously undergone retinal argon laser therapy of ROP in the same center and was matched with the study group for birth weight, gestational age, and length of follow-up. The follow-up examination included sciascopy and automated refractometry (Retinomax 3; Nikon) under cycloplegic conditions and examination of the anterior and posterior segments of the eye.

The study group consisted of 12 eyes of 6 children with a mean (SD) birth weight of 627 (116) g and a mean (SD) age of 24.8 (1.2) weeks. The follow-up examination was performed at a mean (SD) corrected age of 10.5 (2.7) months (Table). The control group included 20 eyes of 10 children (Table). The mean refractive errors for the right eyes and left eyes were significantly less myopic in the study group than in the control group (P = .03 for the right eyes; P = .02 for the left eyes) (Table). Refractive astigmatism did not differ significantly between the groups. An additional child received an intravitreous injection of bevacizumab in her left eye in which an excessive tunica vasculosa lentis prevented retinal laser therapy, and she received retinal argon laser coagulation in her right eye. At a corrected age of 29 months, the refractive error was −8.00 diopters (D) OS and −10.25 D OD. The right eye after laser therapy showed macular ectopia, while the posterior pole of the left eye was unremarkable.

Children receiving intravitreous bevacizumab therapy as compared with children undergoing retinal laser coagulation were significantly less myopic at 1 year of follow-up. Although the cause for myopization in children treated for ROP has remained unclear so far, the results of our study are in line with previous investigations in which myopization was more pronounced in children randomized for the more invasive cryotherapy than in those who received the less invasive laser therapy.⁶ Intravitreous medical therapy for ROP as compared with laser therapy may thus have the following advantages: (1) the possibility of performing the therapy under local anesthesia instead of general anesthesia; (2) the possibility of not destroying the peripheral retina by coagulation; and (3) potentially a lower degree of myopization. Limitations of our study were the small number of included patients, the design as a comparative case series study instead of a randomized trial, and the fact that refractive error can be better determined at a later age. This series provides another premise for a randomized prospective clinical trial.⁴