Author: Sadık Etka Bayramoğlu (Turkey)
Co-authors: Nihat Sayin
Purpose
Peripheral vascular immaturity is a challenging problem encountered in clinical practice after anti-vascular endothelial growth factor (VEGF). It has not been clear whether the incomplete retinal vascularization is due to the nature of the disease or secondary to anti-VEGF in babies who received anti-VEGF injection. However, the effect of different bevacizumab doses on peripheral retinal vascularity is not yet known. The dose of intravitreal bevacizumab (IVB) in the randomized comparative prospective study was 0.625 mg. Since the vitreous volume in premature babies is about a quarter of adults, there are many retrospective studies using 0.3125 mg bevacizumab injection and reporting successful results. In Phase 1 dosing study conducted with a limited number of eyes, it has been reported that it is effective in ROP treatment in doses as low as 0.031 mg. The aim of the presented study is to investigate the effect of drug dose on the progression of retinal vascularization in eyes treated with different doses of İVB.
Setting/Venue
Health Sciences University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Tertiary ROP Center
Methods
Retrospective, comparative, case series. Between May 2018 and December 2019, the patient charts of 142 babies who were administered 0.3125 mg or 0.625 IVB as primary therapy for type 1 ROP or aggressive posterior ROP (APROP) and pre-treatment fundus photographs were retrospectively reviewed. One hundred and four eyes of 52 babies who were treated with the same dose in both eyes, who had fluorescein angiography (FA) at their follow-up and who did not undergo additional IVB, laser, or vitreoretinal surgery until FA, were included in the study. Fifty-six eyes of 28 babies treated with 0.3125 mg bevacizumab were grouped as low dose group, and 48 eyes of 24 babies treated with 0.625 mg bevacizumab were grouped as high dose group. Quantitative measurements were made with the Image J program on the recorded wide-angle images. Horizontal optic disc diameter (HODD), optic disc fovea distance (ODFD), temporal retinal vascularization distance (TRVD) were measured on recorded pre-treatment and FA session images. TRVD is the measurement of the length starting from the optic disc, passing through the fovea to the vascular-avascular border. The plus severity of the pre-treatment photos was scored from one to five.
Results
The mean of week of the first treatment and FA were 36.2 ± 2.2, 65.1 ± 13.8 weeks respectively. In the low dose and high dose group, the pre-treatment TRVD / ODF ratio was 2.40 ± 0.51 and 2.39 ± 0.58 (p = 0.290), respectively. The final TRVD / ODF ratio was 4.13 ± 0.52 and 4.10 ± 0.68, respectively (p = 0.183). The TRVD / ODF ratio increased by 80.49 ± 50.87% and 79.81 ± 49.82%, respectively (p = 0.587). The percentage of increase in the TRVD / ODF ratio was significantly and positively correlated with severity of plus, presence of APROP, FA week, and vascular progression rate of the fellow eye (p = 0.003, r = 0.286; p = 0.000 r = 0.417; p = 0.004 r = 0.280 p = 000, r = 0.697). The percentage of increase in the TRVD / ODF ratio was significantly and negatively correlated with treatment week and pre-treatment TRVD / ODF ratio (p = 0.000, r = -0.343; p = 0.000, r = -0.708). There was no significant correlation between vascularization growth rate and dose of IVB (p = 0.938, r = 0.008).
Conlusions
The severity of the plus disease, the presence of APROP, the increased week of FA, and vascular outgrowth rate of the other eye were positively correlated with the vascular outgrowth. The presence of pre-treatment advanced retinal vascularization and advanced treatment week resulted in a lower rate of vascular outgrowth. Our study shows that treatment with different doses of bevacizumab in ROP did not affect the progression of vascularization and final vascularization.
Financial Disclosure
We declare that we have no financial relationship with companies.
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