Author: Sadık Etka Bayramoğlu (Turkey)
Co-authors: Nihat Sayin
Purpose
The refractive superiority of anti-vascular endothelial growth factor (VEGF) over the laser in posteriorly located premature retinopathy (ROP) cases has been demonstrated in the BEAT-ROP study. Nevertheless, more clinical data are needed to better understand the refractive effect of anti-VEGF administration. Refractive outcomes are not only associated with ROP but also highly correlated with the genetics of the infants and show a high correlation between the eyes. Inter-eye comparison in babies with asymmetric ROP may allow us better to understand the refractive effect of ROP disease and treatment, as it will minimize the genetic difference between the eyes. Since ROP disease occurs due to the expression of a systemic effect on the eye, in general, vascularization is more posteriorly, and the plus is more severe in infants who develop bilateral ROP, whereas when unilateral, vascularization may be further and the severity of plus may be lower. The aim of the study is to compare the refraction difference between the eyes in infants with unilateral more severe ROP and who have undergone intravitreal bevacizumab (IVB) and to determine the mean of difference.
Setting/Venue
Health Sciences University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Tertiary ROP Center
Methods
Retrospective, comparative case series. The patient charts of 43 infants who received IVB monotherapy for Type 1 ROP or aggressive posterior ROP between September 2015 and October 2019 were retrospectively reviewed. The analysis was continued with 66 eyes of 33 infants whose at least one refraction examination with cycloplegia measured with the Plusoptix A09 device recorded. The results of 8 infants who received additional laser treatment were not included in this report. Among the refraction measurements made between the postnatal 6th and 24th months, the closest measurement to the 12th month was accepted as the first-year measurement. The most recent refraction measurement recorded in the patient chart was gained as the final refraction measurement. First-year and final refraction measurements of treated eyes and spontaneously regressed eyes were compared. Normality testing was performed using the Shapiro Wilk test. Comparison of treated and untreated eyes was made by paired t-test.
Results
The mean birth age (BA) of 25 infants was 29.7 ± 2.5 postmenstrual weeks (PMW), and birth weight (BW) was 1400 ± 348 g. The first treatment week was 38.4 ± 2.6 PMW. Twenty-five infants were hospitalized in 16 different neonatal intensive care units (NICU). Of the 25 infants, two were APROP, and the others were Type 1 ROP. Pretreatment retinal vascularization was in zone Ⅰ in two eyes and was in zone Ⅱ in the other 23 treated eyes. The dose of bevacizumab was 0.625 mg in 9 eyes and 0.3125 mg in 16 eyes. The mean of the first-year spherical equivalent (SE) of 21 infants was 1.4 ± 1.9 Diopter (D) in the treated eyes and 1.7 ± 1.4 D in the untreated eyes (p = 0.207). The mean final SE of 25 infants was 1.4 ± 1.9 D in the treated eyes and 2.1 ± 1.8 D in the untreated eyes (p = 0.006). The mean age at the final refraction examination of 25 infants was 23 ± 11 months.
Conlusions
Two factors may have affected the high levels of BA and BW in the infants included in the study: (1) In the country where the study was conducted, severe ROP may develop even in bigger infants due to NICU conditions (2) Infants unilaterally requiring treatment may be relatively bigger than infants requiring bilateral treatment. We found that the mean final refraction was hyperopic in treated and untreated groups. We have found that eyes treated with IVB were found to have a mean SE of 0.7 D lower than eyes that were not treated. Our findings suggest that the development of more severe ROP disease in one eye in the same infant causes a myopic effect in the eye with more severe ROP. Our study does not provide information about whether ROP disease itself or the performed anti-VEGF causes this myopic effect. It may even be thought that the performed anti-VEGF may reduce the myopic impact by regressing the acute phase of the disease. In conclusion, even in eyes with advanced vascularization, a small myopic shift may develop after anti-VEGF treatment.
Financial Disclosure
We declare that we have no financial relationship with companies.
Comments
-
