A spectrum of regression following intravitreal bevacizumab in retinopathy of prematurity. American journal of ophthalmology Chen, T. A., Shields, R. A., Bodnar, Z. H., Callaway, N., Schachar, I. H., Moshfeghi, D. M. 2018


PURPOSE: To describe an improved understanding of the regression patterns following off-label intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP).DESIGN: Retrospective cohort study. MethodsAll infants treated with IVB for Type 1 ROP at a single institution from June 2013 to March 2018 were retrospectively reviewed and the amount of retinal non-perfusion on fluorescein angiogram was calculated. ResultsOnly 3 eyes (3.3%) reached full vascular maturity in the 92 eyes of 46 patients analyzed. Of the 89 eyes not reaching maturity, 39 eyes (43.8%) had vascular arrest alone (VAA), 34 eyes (38.2%) had vascular arrest with persistent tortuosity (VAT), and 16 (18.0%) had ROP reactivation. Those eyes that reactivated were more likely to be initially classified as aggressive posterior ROP (p = 0.004) and of Asian ethnicity (p = 0.008). There were greater areas of ischemia in eyes with reactivation as compared to VAT and VAA (112.1 mm2 vs 72.5 mm2 vs. 56.6 mm2, respectively, p = 0.007). Younger gestational age at birth was found to be an independent predictor of persistent tortuosity (VAT vs. VAA) in a logistic regression model. ConclusionsIncomplete vascularization following IVB is very common and is associated with a younger gestational age at birth, Asian ethnicities, and aggressive posterior ROP. The presence of tortuosity following IVB may be indicative of persistently elevated VEGF levels and an early indicator of potential reactivation.

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