Retinopathy of Prematurity: Bevacizumab vs Laser Treatment

Helen A. Mintz-Hittner, M.D., F.A.C.S. Alfred W. Lasher, III, Professor of Ophthalmology Department of Ophthalmology and Visual Science The University of Texas Health Science Center at Houston-Medical School Cizik Eye ClinicMedicalResearch.com Interview with:
Helen A. Mintz-Hittner, M.D., F.A.C.S.
Alfred W. Lasher, III, Professor of Ophthalmology
Department of Ophthalmology and Visual Science
The University of Texas Health Science Center
at Houston-Medical School
Cizik Eye Clinic

Medical Research: What are the main findings of the study?

Dr. Mintz-Hittner:

  • For retinopathy of prematurity (ROP), at age 2 ½ years, intravitreal bevacizumab (IVB) injections cause less myopia (nearsightedness) in diopters (D) compared to conventional laser therapy (CLT):f
  • or Zone I: -1.51 D versus -8.44 D (7 diopters difference: p = 0.001.
    for Posterior Zone II: -0.58 D versus -5.83 D (5 diopters difference: p = 0.001.


Medical Research: Were any of the findings unexpected?

Dr. Mintz-Hittner: Because Early Treatment for retinopathy of prematurity (ETROP) is the current “standard of care”, it was surprising that the myopia of the patients from Bevacizumab Eliminates the Angiogenic Threat for ROP (BEAT-ROP) compared so well:

  • Rates of myopia ≥5 diopters were quite different when using laser therapy versus no therapy or IVB therapy:
  • 34 to 48% of patients treated with laser therapy with high risk and low risk ROP in ETROP and all risk ROP patients in BEAT-ROP had myopia ≥5 diopters.—compared to—
  • 10 to 12% of patients who had no treatment in ETROP and had intravitreal bevacizumab injections in BEAT-ROP had myopia ≥5 diopters. (Figure 4)

Medical Research: What should clinicians and patients take away from your report?

Dr. Mintz-Hittner: Intravitreal Bevacizumab causes much less myopia than Conventional Laser Therapy, although IVB has only been used for ROP since 2006 and requires longer follow-up for 5% of patients who develop recurrences (BEAT-ROP)compared to CLT which has been used for ROP since the 1990s and requires shorter follow-up for 11% of patients who develop recurrences (ETROP).

Clinicians should use IVB monotherapy or at least inform parents of the option to use IVB monotherapy for severe ROP cases (especially in severe zone I and posterior zone II cases). In these cases of ROP, clinicians should avoid laser either as monotherapy or combination therapy since any early laser therapy in preterm infants with severe retinopathy of prematurity causes destruction of a large area of the peripheral retina (containing growth factors that direct the development of the anterior chamber). Thus, laser therapy used for severe ROP cases impedes the development of the anterior segment—causing steep corneas, shallow anterior chambers, and thickened lenses that are permanent and are a significant morbidity related to laser therapy.

Citation:

 Refractive Outcomes Following Bevacizumab Monotherapy Compared With Conventional Laser Treatment: A Randomized Clinical Trial. Geloneck, M.M., Chuang, A.Z., Clark, W.L., et al. JAMA Ophthalmol. Epub August 7, 2014. Pp. E1-7.

This article is a sequel to: Efficacy of Intravitreal Bevacizumab for Stage 3+ Retinopathy of Prematurity. Mintz-Hittner, H.M., Kennedy, K.A., and Chuang, A.Z. N. Engl, J. Med. February 17, 2011, Pp. 603-615.