Regression Rates Following the Treatment of Aggressive Posterior Retinopathy of Prematurity with Bevacizumab Versus Laser: 8-Year Retrospective Analysis

Abstract

BACKGROUND Retinopathy is a serious complication related to prematurity and a leading cause of childhood blindness. The aggressive posterior form of retinopathy of prematurity (APROP) has a worse anatomical and functional outcome following laser therapy, as compared with the classic form of the disease. The main outcome measures are the APROP regression rate, structural outcomes, and complications associated with intravitreal bevacizumab (IVB) versus laser photocoagulation in APROP. MATERIAL AND METHODS This is a retrospective case series that includes infants with APROP who received either IVB or laser photocoagulation and had a follow-up of at least 60 weeks (for the laser photocoagulation group) and 80 weeks (for the IVB group). In the first group, laser photocoagulation of the retina was carried out and in the second group, 1 bevacizumab injection was administered intravitreally. The following parameters were analyzed in each group: sex, gestational age, birth weight, postnatal age and postmenstrual age at treatment, APROP regression, sequelae, and complications. Statistical analysis was performed using Microsoft Excel and IBM SPSS (version 23.0). RESULTS The laser photocoagulation group consisted of 6 premature infants (12 eyes) and the IVB group consisted of 17 premature infants (34 eyes). Within the laser photocoagulation group, the evolution was favorable in 9 eyes (75%) and unfavorable in 3 eyes (25%). Within the IVB group, APROP regressed in 29 eyes (85.29%) and failed to regress in 5 eyes (14.71%). These differences are statistically significant, as proved by the McNemar test (P<0.001). CONCLUSIONS The IVB group had a statistically significant better outcome compared with the laser photocoagulation group, in APROP in our series.

Figure 1

(A) RE – very tortuous, moderately dilated retinal vessels in the posterior pole, no visible ridge, the temporal retinal vessels are more dilated than the nasal ones; (B) RE – arterio-venous shunting throughout the posterior-pole; (C) RE – inferior retinal hemorrhage; (D, E) RE – the black and white images identify more clearly, the limit between the vascularized and non-vascularized retina, revealing the extent of avascular retina.

Figure 2

(A) LE – very tortuous, moderately dilated retinal vessels in the posterior pole, no visible ridge, the temporal retinal vessels are more dilated than the nasal ones; (B, C) LE – arterio-venous shunting and inferior retinal hemorrhage are visible; (D) LE – the black and white image displays better the arterio-venous shunts and reveal more clearly, the limit between the vascular and avascular retina.

Figure 3

(A, B) RE (color and black and white image) – pigmented laser scars, persistence of dilated retinal vessels, especially in the temporal side, skipped areas towards the macular region.

Figure 4

(A) LE – posterior pole and temporal retina - pigmented laser scars, skipped areas towards the posterior pole and macular region, retinal vessels still tortuous and moderately dilated; (B) LE – at the level of the nasal retina, no skipped areas are visible, the nasal vessels are less dilated than the temporal ones.

Figure 5

(A) RE – retinal vessels are very tortuous and form a syncytial pattern; (B, C) RE – arterio-venous shunts are visible, indicating that retinal vessels are not going to grow towards the periphery, the landmarks of the macular region are not individualized; (D) RE – the black and white image shows more precisely the length of the retinal vessels, the arterio-venous shunts and the extent of avascular retina; (E) RE – 5 days after IVB, the retinal vessels are significantly less tortuous and dilated and, arterio-venous shunting is less obvious.

Figure 6

(A–D) Present the aspects in LE, which are similar to Figure 5A–5D RE. (E) Shows the aspect of the RE, 5 days following IVB, the retinal vessels are significantly less tortuous and dilated, arterio-venous shunting is less obvious.

Figure 7

(A) RE – retinal vessels are more tortuous than dilated, especially the veins, inferior preretinal fibrosis, accompanied by a preretinal hemorrhage; retinal vessels are very short, a large area of non-vascularized retina is identified; (B) RE – preretinal fibrosis extends along the infero-temporal vascular arcade, temporal retina is avascular.

Figure 8

(A) LE – retinal vessels (mainly the veins) are tortuous and dilated throughout the posterior pole, arterio-venous shunting is present, no visible ridge; (B) LE – the temporal limit between the vascular and avascular retina is clearly visible as a highly vascularized tissue; there is no retinal traction yet; (C) LE – arterio-venous shunts developed between the vascular arcades; (D) LE – the black and white photo reveals the extent of avascular retina; (E, F) LE – 8 weeks from IVB, ROP regressed, retinal vessels are normal and the ancient limit between the vascularized and nonvascularized retina is identifiable (F).