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Study reviews risk of recurrence in infants treated with anti-VEGF for ROP
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Recurrence is not uncommon in infants with certain types of retinopathy of prematurity who were treated with intravitreal bevacizumab monotherapy, according to a study. Incidence of recurrence in the infants was 8.3%.
The retrospective case series looked at rate and patterns of recurrence in 471 eyes of 241 infants with type 1 ROP, divided into stage 3+ ROP and aggressive posterior ROP, in zone I or zone II posterior who were treated with intravitreal Avastin (bevacizumab, Genentech) as monotherapy. Dose was 0.625 mg, given in accordance with the BEAT-ROP study protocol.
Of the 20 infants who experienced recurrence, recurrence occurred between 45 and 55 weeks of adjusted age in 18 infants.
“We believe clinicians should be more vigilant in their examinations for recurrence during the 45- to 55-week [adjusted age] recurrence window and should perform more frequent examinations during this time,” the study authors said.
RetCam fundus photography (Clarity Medical Systems) was used before the first injection to document the type of ROP, before the second injection in eyes with recurrence and during follow-up.
Among risk factors for recurrence found in this study were immaturity factors such as low birth weight, low gestational age and zone 1 ROP, aggressive posterior ROP and cumulative health issues – by Kate Sherrer
Disclosure: The authors report no relevant financial disclosures.
Perspective
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R.V. Paul Chan, MD
This paper addresses a very important question, which is, when does recurrence of ROP happen after intravitreal anti-VEGF injection, what are potential risk factors for this, and what are potential patterns of recurrence?
The study by Mintz-Hittner and colleagues looks at recurrence of ROP after injection of 0.625 mg of bevacizumab intravitreally for zone I stage 3+, posterior zone II stage 3+ and aggressive posterior retinopathy of prematurity (APROP). It does not, however, seem to cover all cases of type 1 ROP.
It is a retrospective study with a large study group that includes patients from the BEAT-ROP study, although these patients represent a minority of patients among the whole cohort. And, most of the patients are single-investigator treated, which is an important consideration. There can be significant variability in how people diagnose APROP, which was one of the potential risk factors for recurrence that the study found, but identification of APROP was dependent on the single investigator’s determination.
I think one important finding that the paper demonstrated was that recurrence occurred during the window of 45 to 55 weeks, which then presents new questions such as: Should we be more vigilant in our follow-up during this period of time when we see these children? Should this be the time period when we start to think about doing a fluorescein angiogram or performing an examination under anesthesia?
The authors also cite “known” risk factors for recurrence, but these findings should be balanced with the fact that this is a retrospective study. Furthermore, we still do not know how often or how frequently to follow these children. We still do not know what the end point is when we can stop performing frequent dilated funduscopic examinations on these patients or when we can feel comfortable that recurrence will not occur. And, would combination treatment with both laser and anti-VEGF therapy be better, worse or the same as giving monotherapy intravenous bevacizumab or monotherapy laser?
In short, there is more to learn in a controlled fashion.
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Mintz-Hittner HA, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.04.028.
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