Neurodevelopmental Outcomes Comparing Bevacizumab to Laser for Type 1 ROP
Sarah Hilkert Rodriguez; Katherine Lewis; Mark Greenwald; Nandita Anand; Michael Blair
The University of Chicago
Introduction: Despite superior ocular outcomes for posterior type 1 ROP, use of intravitreal bevacizumab (IVB) remains controversial, largely due to potential adverse systemic effects.1,2 This study evaluates neurodevelopmental outcomes at our institution, where eyes with posterior type 1 ROP received laser before and IVB after the publication of BEAT-ROP.
Methods: Chart reviews identified 41 infants with laser and 48 with IVB from 2006-2016. Primary outcomes were Bayley-3 scores (BSID-III’s), collected for another NICU study. Secondary outcomes were developmental delay, cerebral palsy, hearing loss, and bilateral visual impairment.
Results: Baseline characteristics were similar by treatment group. Mean BSID-III’s were: cognitive 77.0 and 76.7, p = 0.97; language 83.8 and 84.5, p = 0.91; motor 81.2 and 77.3, p = 0.70; total 242 and 233, p = 0.68, in the IVB (n = 13) and laser (n = 9) groups, respectively. Severe delay (component score < 85) was common: 78% with laser and 69% with IVB (NS). Comparing all infants, secondary outcomes trended favorably for IVB, with a significant decrease in the rate of cerebral palsy.
Discussion: In contrast to the recent Canadian study, IVB was not associated with adverse developmental effects in this analysis.3 Baseline differences, propensity to treat sicker infants with IVB, and imbalance in exclusion criteria likely biased results of the previous study. In this study, the number and characteristics of patients excluded from BSID-III analysis are similar in each group.
Conclusion: Although developmental delay was common in both groups, there were no significant differences in primary outcomes by treatment group. The before/after study design minimizes selection bias.
1. Mintz-Hittner H, Kennedy KA, Chuang AZ. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med. 2011;364(7):603-615.
2. Wu WC., Lien R., Liao PJ., Wang, NK., Chen, YP., Chao, A.N., et al. Serum levels of vascular endothelial growth factor and related factors after intravitreous bevacizumab injection for retinopathy of prematurity. JAMA Ophthalmology. 2015;133(4):391-397.Morin J, Luu TM, Superstein R, Ospina, L.H., Lefebvre F., Simard M.N., et al.
3. Neurodevelopmental outcomes following bevacizumab injections for retinopathy of prematurity. Pediatrics. 2016;137(4):e20153218.