Ultra-low-dose intravitreal bevacizumab improves severe, posterior ROP
Using 0.16-mg intravitreal bevacizumab (IVB) has improved severe and posterior retinopathy of prematurity (ROP), with no adverse ocular outcomes occurring in the series, reports a recent study.
IVB injection was performed in 29 eyes of 15 infants. ‘Treatment success’ was defined as complete regression of retinopathy and vascularization into (or laser ablation of) zone 3.
Of the 29 eyes, 23 (79.3 percent) achieved primary success in response to IVB 0.16 mg alone, and 27 (93.1 percent) achieved secondary success, where additional treatment was required. During follow-up, one infant death was recorded due to respiratory disease.
Six of the total number of eyes (20.6 percent) underwent retreatment. Retreatments occurred at a mean of 9.8 weeks following initial IVB (range, 6‒15) and at a mean of 44 weeks postmenstrual age (range, 40‒50).
The authors conducted a retrospective observational case series of consecutive infants who underwent ultra-low-dose IVB injection for the management of ROP at a regional neonatal intensive care unit in the North East of England between November 2013 and August 2016.
IVB has emerged as an effective treatment modality for the management of severe and posterior ROP, but despite evidence of systemic vascular endothelial growth factor suppression and concerns about how this might affect the developing neonate, the optimal dose has remained unknown, according to the authors.
A 2013 study in Taiwan had shown the efficacy and safety of IVB injection in treating prethreshold ROP. Researchers, however, said that laser therapy might still be needed as backup treatment for patients who do not respond to an IVB injection or for those in whom ROP worsen after an IVB injection. [Am J Ophthalmol 2013;155:150-158.e1]