Paper 35

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Refractive Outcomes Comparing Primary Laser to Primary Bevacizumab with Delayed Laser for Type 1 ROP

 Nandita Anand, MD; Michael P. Blair, MD; Kate Lewis, MS; Sarah Hilkert Rodriguez, MD, MPH
Univeristy of Chicago
Chicago, Illinois

Introduction:  The treatment of retinopathy of prematurity (ROP) with intravitreal bevacizumab (IVB) has been associated with less myopia than laser (1). Due to concerns about late reactivation after treatment with IVB beyond conventional screening guidelines, completion of treatment with laser ablation to persistent avascular retina has been recommended (2,3).  This study evaluates refractive outcomes comparing eyes treated with IVB and delayed laser (IVB-PRP) to eyes treated with primary laser (PRP).

Methods:  Retrospective chart review from 2006-2016 identified 89 treated patients.  Patients with type 1 ROP were treated with PRP before the publication of BEAT-ROP. After BEAT-ROP, these patients were treated with IVB-PRP.  Cycloplegic refractions at 2-4 years were available for 14 patients (25 eyes) after PRP and 16 patients (31 eyes) after IVB-PRP.  An additional 3 patients (6 eyes) received IVB monotherapy.

Results:  Mean spherical equivalent (SE) was -7.76 among patients who received PRP and -0.24 among patients who received IVB-PRP (p < 0.0001).  Mean age at refraction was not significantly different between the two groups (3.12 and 2.87 years, p = 0.231).   Compared to the small group who received IVB monotherapy (mean SE +0.71), refraction was similar among patients who received IVB-PRP (p = 0.535).

Discussion:  Infants who received IVB-PRP were significantly less myopic than infants who received PRP.  Despite a trend towards slightly older age at refraction in the PRP group, a few months would not explain this large refractive difference.

Conclusion:  Delayed laser is recommended after IVB to prevent late retinal detachment. This does not increase undesirable refractive outcomes.

1. Hwang CK, Hubbard GB, Hutchinson AK, Lambert SR. Outcomes after intravitreal bevacizumab versus laser photocoagulation for retinopathy of prematurity: A 5-year retrospective analysis. Ophthalmology. 2015;122(5):1008-1015.
2.Toy BC, Schachar IH, Tan GSW, Moshfeghi DM. Chronic vascular arrest as a predictor of bevacizumab treatment failure in retinopathy of prematurity. Ophthalmology. 2016;123(10):2166-2175.
3.Garcia Gonzalez JM, Snyder L, Blair M, Rohr A, Shapiro M, Greenwald M. Prophylactic peripheral laser and fluorescein angiography after bevacizumab for retinopathy of prematurity. Retina. 2017 [Epub ahead of print].

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