Neurodevelopmental outcomes in infants with retinopathy of prematurity treated with bevacizumab versus laser
Author Disclosure Block: M. Isaac: None. K. Raghuram: None. A. AlAli: None. K. Mireskandari: None. P.S. Shah: None. N. Tehrani: None.
Abstract Body:
Purpose: To compare neurodevelopmental outcomes at 18-24 months corrected age (CA) in preterm infants treated with intravitreal bevacizumab injection (IVB) to those treated with conventional laser ablation.
Study Design: Retrospective cohort study.
Methods: We included all infants treated for retinopathy of prematurity (ROP) between April 2009 and June 2015. Infants who died before neurodevelopmental assessment, infants with major congenital or chromosomal anomalies, and those with no follow-up data available were excluded. We also excluded infants who were treated for compassionate reasons and who received both IVB and laser. Baseline characteristics were extracted by directly reviewing patients’ charts and from both the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-up Network (CNFUN) databases. Maternal and neonatal characteristics and neonatal comorbidities were collected. The primary outcome is moderate-severe neurodevelopmental impairment (NDI), evaluated at 18-24 months corrected age. Bayley Scales of Infant Development, Third Edition (BSID III), were used for the assessment of NDI. Baseline ROP parameters, treatment modality and postmenstrual age at treatment were collected. Secondary neurodevelopmental outcomes included the presence or absence of cerebral palsy, bilateral visual loss and hearing loss requiring amplification. Secondary ROP outcomes included structural, visual and refraction outcomes as defined by the ETROP at 24±6 months CA. Descriptive statistics, Pearson Chi-square or Fisher exact test were used for categorical variables and Student t-test and ANOVA F-test were used for continuous variables. Odds ratio for moderate to severe NDI was calculated for both groups.
Results: Eighty-eight infants were treated for ROP during the study period. Fifty-six infants met inclusion criteria (29 IVB and 27 laser-treated). Neurodevelopmental assessment at this time was available for 21 and 16 infants treated with IVB and laser, respectively. 72.4% and 59.3% of all treated IVB and laser infants, respectively, had moderate to severe NDI (OR 1.8, 95% CI 0.59, 5.53, p=0.3). Mean visual acuity was 0.41±0.26 and 0.45±0.44 for the IVB and laser groups respectively (p=0.65). Mean spherical equivalent was -3.23±5.15 and -4.62±5.76 for the IVB and laser groups, respectively (p=0.23). All treated infants in both groups had favorable structural outcomes.
Conclusions: Preliminary results from this study show similar neurodevelopmental outcomes in patients treated with IVB and laser. The results of our study are particularly relevant in light of increasing use of anti-VEGF agents in the treatment of severe ROP.
