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Catt C, Pfeil JM, Barthelmes D, Gole GA, Krohne TU, Wu WC, Kusaka S, Zhao P, Dai S, Elder J, Heckmann M, Stack J, Khonyongwa-Fernandez G, Stahl A. Development of a joint set of database parameters for the EU-ROP and Fight Childhood Blindness! ROP Registries. Br J Ophthalmol 2024; 108:1030-1037. [PMID: 37704267 DOI: 10.1136/bjo-2023-323915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND/AIMS The incidence of retinopathy of prematurity (ROP) is increasing and treatment options are expanding, often without accompanying safety data. We aimed to define a minimal, patient-centred data set that is feasible to collect in clinical practice and can be used collaboratively to track and compare outcomes of ROP treatment with a view to improving patient outcomes. METHODS A multinational group of clinicians and a patient representative with expertise in ROP and registry development collaborated to develop a data set that focused on real-world parameters and outcomes that were patient centred, minimal and feasible to collect in routine clinical practice. RESULTS For babies receiving ROP treatment, we recommend patient demographics, systemic comorbidities, ROP status, treatment details, ophthalmic and systemic complications of treatment, ophthalmic and neurodevelopmental outcomes at initial treatment, any episodes of retreatment and follow-up examinations in the short and long-term to be collected for use in ROP studies, registries and routine clinical practice. CONCLUSIONS We recommend these parameters to be used in registries and future studies of ROP treatment, to reduce the variation seen in previous reports and allow meaningful assessments and comparisons. They form the basis of the EU-ROP and the Fight Childhood Blindness! ROP Registries.
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Affiliation(s)
- Caroline Catt
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Johanna M Pfeil
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Daniel Barthelmes
- The Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, University Hospital Zurich, Zurich, Zürich, Switzerland
| | - Glen A Gole
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Tim U Krohne
- Department of Ophthalmology, University of Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taiwan
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine Hospital, Osakasayama, Japan
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - James Elder
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Karmouta R, Strawbridge JC, Langston S, Altendahl M, Khitri M, Chu A, Tsui I. Neurodevelopmental Outcomes in Infants Screened for Retinopathy of Prematurity. JAMA Ophthalmol 2023; 141:1125-1132. [PMID: 37883103 PMCID: PMC10603571 DOI: 10.1001/jamaophthalmol.2023.4787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/02/2023] [Indexed: 10/27/2023]
Abstract
Importance Preterm infants screened for retinopathy of prematurity (ROP) are at risk for heterogenous neurodevelopment outcomes that are difficult to predict. Objective To characterize the potential association between socioeconomic and clinical risk factors and neurodevelopmental outcomes in a diverse, multicenter cohort of premature neonates screened for ROP. Design, Setting, and Participants This was a retrospective cohort study using electronic medical records and US Census Bureau income data. This study was performed at academic (University of California, Los Angeles [UCLA] Mattel Children's Hospital and UCLA Santa Monica Hospital), community (Cedars-Sinai Medical Center), and LA county (Harbor-UCLA Medical Center) neonatal intensive care units. Participants included infants who met American Academy of Pediatrics guidelines for ROP screening and had records from at least 1 Bayley Scales of Infant and Toddler Development (BSID) neurodevelopment assessment between 0 and 36 months of adjusted age. Data analyses were conducted from January 1, 2011, to September 1, 2022. Exposures Demographic and clinical information, proxy household income, and health insurance type were collected as risk factors. Main Outcomes and Measures Neurodevelopmental outcomes in the cognitive, language, and motor domains measured via BSID were the primary outcomes. Results A total of 706 infants (mean [SD] age, 28.6 [2.4] weeks; 375 male [53.1%]) met inclusion criteria. In a multivariable model, which included adjustments for birth weight, sex, insurance type, intraventricular hemorrhage (IVH), and age at assessment, public health insurance was associated with a 4-fold increased risk of moderate to severe neurodevelopmental impairment (NDI) in cognitive and language domains (cognitive, odds ratio [OR], 3.65; 95% CI, 2.28-5.86; P = 8.1 × 10-8; language, OR, 3.96; 95% CI, 2.61-6.02; P = 1.0 × 10-10) and a 3-fold increased risk in the motor domain (motor, OR, 2.60; 95% CI, 1.59-4.24; P = 1.4 × 10-4). In this adjusted model, clinical factors that were associated with an increased risk of moderate to severe NDI included lower birth weight, diagnosis of IVH, male sex, and older age at time of Bayley assessment. In unadjusted analyses, infants who received either laser or anti-VEGF treatment, compared with infants without treatment-requiring ROP, had lower BSID scores in multiple domains at 0 to 12 months, 12 to 24 months, and 24 to 36 months (DATA). In the multivariable model, treatment type was no longer associated with worse neurodevelopmental outcomes in any domain. Conclusions and Relevance Study results suggest an association between public insurance type and NDI in a diverse population screened for ROP, indicating the complexities of neurodevelopment. This study also supports the early neurodevelopmental safety of anti-VEGF treatment, as anti-VEGF therapy was not found to be independently associated with worse NDI in any domain.
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Affiliation(s)
- Reem Karmouta
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
| | - Jason C. Strawbridge
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
| | - Seth Langston
- Division of Neonatology, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marie Altendahl
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Monica Khitri
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Irena Tsui
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
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Msall ME. Improving neurodevelopmental trajectories after retinopathy of prematurity: challenges and opportunities. Pediatr Res 2023; 94:1598-1599. [PMID: 35292728 DOI: 10.1038/s41390-022-02019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Michael E Msall
- University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, 950 East 61st Street Room 207, Chicago, IL, 60637, USA.
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4
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Baiad AA, Kherani IZ, Popovic MM, Katsnelson G, Muni RH, Mireskandari K, Tehrani NN, Zhou TE, Kertes PJ. A Meta-Analysis of Neurodevelopmental Outcomes following Intravitreal Bevacizumab for the Treatment of Retinopathy of Prematurity. Neonatology 2023; 120:577-588. [PMID: 37487481 PMCID: PMC10777715 DOI: 10.1159/000531541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is the most common cause of preventable blindness in preterm infants. First-line treatments include intravitreal bevacizumab (IVB) or laser photocoagulation (LPC). OBJECTIVES The aim of the study was to evaluate neurodevelopmental safety of IVB compared to LPC for ROP. METHODS MEDLINE, Embase, and Cochrane library were searched up to September 2022. Studies were included with at least 12-month follow-up of primary outcomes such as severe neurodevelopmental impairment (sNDI), cerebral palsy (CP), and hearing impairment (HI). Secondary outcomes were moderate-to-severe neurodevelopmental impairment (msNDI), Bayley Scores of Infant Development (BSID-III), and visual impairment. RESULTS 1,231 patients from 11 comparative studies were included. Quality of evidence was rated low for all outcomes. IVB was associated with a higher risk for sNDI (risk ratio [RR] = 1.25, 95% confidence interval [CI]: [1.01, 1.53], p = 0.04); and CP (RR = 1.40, CI: [1.08, 1.81], p = 0.01) compared to LPC. There was no significant difference between IVB and LPC for msNDI (RR = 1.15, CI: [0.98, 1.35], p = 0.08) and HI (RR = 1.43, CI: [0.86, 2.39], p = 0.17). BSID-III percentile scores were similar between IVB and LPC, with weighted mean differences of 1.51 [CI = -1.25, 4.27], 2.43 [CI = -1.36, 6.22], and 1.97 [CI = -1.06, 5.01] for cognitive, language, and motor domains, respectively (p > 0.05). CONCLUSION To our knowledge, this is the largest meta-analysis on neurodevelopmental outcomes and the first to rigorously examine IVB monotherapy in ROP treatment. Compared to LPC, there was a marginally increased risk for sNDI and CP with IVB but little or no difference in the risk of msNDI and HI. Further randomized studies are needed to strengthen these findings.
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Affiliation(s)
- Abed A Baiad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada,
| | - Imaan Z Kherani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Glen Katsnelson
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nasrin N Tehrani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tianwei Ellen Zhou
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Chiang MC, Chen YT, Kang EYC, Chen KJ, Wang NK, Liu L, Chen YP, Hwang YS, Lai CC, Wu WC. Neurodevelopmental Outcomes for Retinopathy of Prematurity: A Taiwan Premature Infant Follow-up Network Database Study. Am J Ophthalmol 2023; 247:170-180. [PMID: 36343698 DOI: 10.1016/j.ajo.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/29/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the neurodevelopmental outcomes in premature infants who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections to treat retinopathy of prematurity (ROP). DESIGN Retrospective cohort study. METHODS This study was conducted using the database from the Taiwan Premature Infant Follow-up Network. Demographic data, systemic risk factors, ROP status, and neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) were collected. Patients were divided into 4 groups: prematurity without ROP, ROP without treatment, ROP with laser treatment, and ROP with intravitreal anti-VEGF treatment. A generalized estimating equation was used for analyzing repeated measurements of Bayley-III at the corrected ages of 6, 12, and 24 months. RESULTS A total of 2090 patients with a mean gestational age of 31.2 weeks were included. The Bayley-III composite scores of patients with ROP treated with anti-VEGF were comparable to those of patients with ROP without treatment (cognitive: P = .491; language: P = .201; motor: P = .151) and premature patients without ROP (cognitive: P = .985; language: P = .452; motor: P = .169) after adjusting for confounders. Patients with ROP treated with laser photocoagulation exhibited poorer cognitive composite scores than did those without treatment (P < .001), premature patients without ROP (P < .001), and those treated with anti-VEGF (P < .001), but they had similar language and motor composite scores. CONCLUSIONS Intravitreal anti-VEGF treatment for ROP was not associated with adverse neurodevelopment in premature infants. Further studies are needed to determine whether general anesthesia or sedation used in laser treatment for ROP has significant impacts on neurodevelopmental outcomes.
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Affiliation(s)
- Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics (M.-C.C), Chang Gung Memorial Hospital, Linkou, Taiwan; Taiwan Premature Infant Follow-up Network (M.-C.C); College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan
| | - Yen-Ting Chen
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (Y.-T.C., Y.-P.C.), New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Eugene Yu-Chuan Kang
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Jen Chen
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Nan-Kai Wang
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Laura Liu
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yen-Po Chen
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (Y.-T.C., Y.-P.C.), New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chun Lai
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (C.-C.L.), Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wei-Chi Wu
- College of Medicine (M.-C.C., Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H., C.-C.L., W.-C.W.), Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Taiwan Premature Infant Follow-up Network (Y.-T.C., E.Y.-K, K.-J.C., N.-K.W, L.L., Y.-P.C., Y.-S.H.,, C.-C.L., W.-C.W.), Chang Gung Memorial Hospital, Linkou, Taiwan.
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Rodriguez SH, Blair MP, Timtim E, Millman R, Si Z, Wroblewski K, Andrews B, Msall ME, Peyton C. Smartphone application links severity of retinopathy of prematurity to early motor behavior in a cohort of high-risk preterm infants. J AAPOS 2023; 27:12.e1-12.e7. [PMID: 36642242 PMCID: PMC10243477 DOI: 10.1016/j.jaapos.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the General Movement Assessment (GMA) with the Motor Optimality Score-Revised (MOS-R) as a neurodevelopmental marker in infants with retinopathy of prematurity (ROP). METHODS Infants screened prospectively for ROP were evaluated at 3 months' post-term age using a smartphone application to complete the GMA and MOS-R. Results were analyzed by ROP severity. RESULTS Of 105 enrolled infants, 83 completed the study. Of these, 54 (65%) had any ROP, 32 (39%) had severe ROP, and 13 (16%) had type 1 ROP. The proportion with aberrant GMA was significantly higher in infants with severe ROP (14/32 [44%]) compared with infants who had milder ROP (8/51 [16%]; P = 0.006). Of those with severe ROP, there was no significant difference comparing infants with type 1 ROP treated with bevacizumab (7/13 [54%]) to infants with type 2 ROP without treatment (7/19 [37%]; P = 0.47). Although the presence of any ROP, stage of ROP, and severe ROP each predicted lower MOS-R scores on univariate analyses, only severe bronchopulmonary dysplasia and markers of brain injury remained significant in the multivariate analysis. CONCLUSIONS The GMA was a convenient, short-term method of data collection with low attrition. Although severe ROP initially appeared linked to poor early motor scores, this association is likely confounded by neurological and respiratory complications, which frequently accompany severe ROP.
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Affiliation(s)
| | - Michael P Blair
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois; Retina Consults Ltd, Des Plaines, Illinois
| | - Elise Timtim
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Ryan Millman
- Department of Physical Therapy and Human Movement Science, Northwestern University
| | - Zhuangjun Si
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | | | - Bree Andrews
- Department of Pediatrics, Section of Neonatology, University of Chicago
| | - Michael E Msall
- Department of Pediatrics, Section of Developmental and Behavioral Pediatrics and Kennedy Research Center on Neurodevelopmental Disabilities, University of Chicago, Chicago, Illinois
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Science, Northwestern University
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Binenbaum G. Bevacizumab for retinopathy of prematurity and neurodevelopment. J AAPOS 2023; 27:1-2. [PMID: 36623638 DOI: 10.1016/j.jaapos.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Gil Binenbaum
- Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Buerger-11, Philadelphia PA 19104.
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8
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Diggikar S, Gurumoorthy P, Trif P, Mudura D, Nagesh NK, Galis R, Vinekar A, Kramer BW. Retinopathy of prematurity and neurodevelopmental outcomes in preterm infants: A systematic review and meta-analysis. Front Pediatr 2023; 11:1055813. [PMID: 37009271 PMCID: PMC10050340 DOI: 10.3389/fped.2023.1055813] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/16/2023] [Indexed: 04/04/2023] Open
Abstract
Background Retinopathy of prematurity (ROP) and abnormal brain development share similar risk factors and mechanisms. There has been contrasting evidence on the association of ROP with adverse neurodevelopmental outcomes. Objective We analysed the association between ROP at levels of severity and treatment with all neurodevelopmental outcomes until adolescence. Data source We followed PRISMA guidelines and searched Medline and Embase between 1 August 1990 and 31 March 2022. Study selection and participants Randomised or quasi-randomised clinical trials and observational studies on preterm infants (<37 weeks) with ROP [type 1 or severe ROP, type 2 or milder ROP, laser or anti-vascular endothelial growth factor (VEGF) treated] were included. Data extraction and synthesis We included studies on ROP and any neurocognitive or neuropsychiatric outcomes. Outcomes The primary outcomes were as follows: cognitive composite scores evaluated between the ages of 18 and 48 months by the Bayley Scales of Infant and Toddler Development (BSID) or equivalent; neurodevelopmental impairment (NDI; moderate to severe NDI or severe NDI), cerebral palsy, cognitive impairment; and neuropsychiatric or behavioural problems. The secondary outcomes were as follows: motor and language composite scores evaluated between the ages of 18 and 48 months by BSID or equivalent; motor/language impairment; and moderate/severe NDI as defined by the authors. Results In preterm infants, "any ROP" was associated with an increased risk of cognitive impairment or intellectual disability [n = 83,506; odds ratio (OR): 2.56; 95% CI: 1.40-4.69; p = 0.002], cerebral palsy (n = 3,706; OR: 2.26; 95% CI: 1.72-2.96; p < 0.001), behavioural problems (n = 81,439; OR: 2.45; 95% CI: 1.03-5.83; p = 0.04), or NDI as defined by authors (n = 1,930; OR: 3.83; 95% CI: 1.61-9.12; p = 0.002). Type 1 or severe ROP increased the risk of cerebral palsy (OR: 2.19; 95% CI: 1.23-3.88; p = 0.07), cognitive impairment or intellectual disability (n = 5,167; OR: 3.56; 95% CI: 2.6-4.86; p < 0.001), and behavioural problems (n = 5,500; OR: 2.76; 95% CI: 2.11-3.60; p < 0.001) more than type 2 ROP at 18-24 months. Infants treated with anti-VEGF had higher odds of moderate cognitive impairment than the laser surgery group if adjusted data (gestational age, sex severe intraventricular haemorrhage, bronchopulmonary dysplasia, sepsis, surgical necrotising enterocolitis, and maternal education) were analysed [adjusted OR (aOR): 1.93; 95% CI: 1.23-3.03; p = 0.04], but not for cerebral palsy (aOR: 1.29; 95% CI: 0.65-2.56; p = 0.45). All outcomes were adjudged with a "very low" certainty of evidence. Conclusion and relevance Infants with "any ROP" had higher risks of cognitive impairment or intellectual disability, cerebral palsy, and behavioural problems. Anti-VEGF treatment increased the risk of moderate cognitive impairment. These results support the association of ROP and anti-VEGF treatment with adverse neurodevelopmental outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022326009.
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Affiliation(s)
- Shivashankar Diggikar
- Department of Paediatrics, Oyster Woman and Child Hospital, Bengaluru, India
- Correspondence: Shivashankar Diggikar
| | - Puvaneswari Gurumoorthy
- Centre for Cellular and Molecular Platforms, National Centre for Biological Sciences, Bengaluru, India
| | - Paula Trif
- Department of Neonatology, Emergency County Hospital of Bihor, Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Diana Mudura
- Department of Neonatology, Emergency County Hospital of Bihor, Oradea, Romania
| | | | - Radu Galis
- Department of Paediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, India
| | - Anand Vinekar
- Department of Paediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, India
| | - Boris W. Kramer
- Department of Paediatrics, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
- School of Women’s and Infants’ Health, University of Western Australia, Crawley, WA, Australia
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Zhang DL, Yoon HH, deRegnier RAO, Arzu J, Rahmani S. Postnatal Growth Trajectories and Neurodevelopmental Outcomes Following Bevacizumab Treatment for Retinopathy of Prematurity. Clin Ophthalmol 2022; 16:2713-2722. [PMID: 36035240 PMCID: PMC9401100 DOI: 10.2147/opth.s378520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the postnatal growth and neurodevelopment of infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB). Patients and Methods This was a retrospective comparative study. A total of 262 infants were divided among three study groups: 22 treated with intravitreal bevacizumab, 55 treated with laser, and 185 with ROP that resolved without treatment. Infants with nonviable course or hydrocephalus, a source of non-physiologic weight gain, were excluded. Neurodevelopment was assessed with Bayley III scores at 17–28 months if available and presence of hearing loss or cerebral palsy. Weekly weight, height, and head circumference from birth through 50 weeks postmenstrual age (PMA) were modeled to determine differences in growth trajectories following treatment. Results Comparison of postnatal growth curves from the time of treatment to 50 weeks PMA showed no significant differences in growth trajectories between groups after adjusting for the corresponding growth parameters at birth. Comparison of Bayley scores in patients with available data (n = 120) showed no significant differences. There was an increased risk of cerebral palsy in the IVB group after logistic regression adjusting for baseline confounders, but this did not retain statistical significance after applying the false discovery rate correction for multiple testing. Conclusion To our knowledge, this is the first large retrospective study to examine longitudinal growth in infants treated with IVB compared to controls. There were no significant differences in postnatal growth or neurodevelopmental outcomes between groups, which overall continue to support the safety of bevacizumab treatment for ROP.
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Affiliation(s)
- David L Zhang
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hawke H Yoon
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Raye-Ann O deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jennifer Arzu
- Division of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Safa Rahmani
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Correspondence: Safa Rahmani, Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA, Tel +1 312 227-6180, Fax +1 312 227-9411, Email
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Webb AR. Neurodevelopmental Outcomes Associated With Intravitreal Bevacizumab Injections for Retinopathy of Prematurity. Adv Neonatal Care 2022; 22:154-160. [PMID: 33938477 DOI: 10.1097/anc.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a common disorder among premature infants associated with significant morbidity. The current standard of care includes laser ablation therapy when needed. While intravitreal bevacizumab (IVB) injections have emerged as a new therapy for ROP, so have concerns about the systemic effects of the bevacizumab (Avastin), specifically on neurodevelopmental outcomes. PURPOSE To review the current literature on the impact of IVB on neurodevelopmental outcomes in neonates with ROP to inform nurses' knowledge and practice. METHODS A literature search was performed in the PubMed, CINAHL, and Embase databases. Eleven primary studies examining neurodevelopmental outcomes related to IVB were identified and reviewed. RESULTS Limitations of current studies, including small sample sizes, retrospective analysis subject to selection bias, and confounding factors such as sedation/anesthesia exposure, prevent robust conclusions from being drawn. However, there is not currently any clear evidence of negative neurodevelopmental impacts associated with IVB despite a sound theoretical basis for concern. IMPLICATIONS FOR PRACTICE Nurses should include all known and potential risks and benefits when counseling families and developing individualized plans of care for their neonatal patients with ROP. IMPLICATIONS FOR RESEARCH Well-designed, prospective studies examining neurodevelopmental outcomes at later time points are needed to conclusively support or disprove results of IVB therapy for ROP in the context of potential adverse effects.
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11
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The role of anti-vascular endothelial growth factor in treatment of retinopathy of prematurity-a current review. Eye (Lond) 2022; 36:1532-1545. [PMID: 35017699 PMCID: PMC9307789 DOI: 10.1038/s41433-021-01922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
The review aims to evaluate the uses of conventional laser therapy and intravitreal injection of various anti-VEGF in terms of efficacy and side effects for the treatment of retinopathy of prematurity. A literature search of the publication, concerning conventional laser treatment and intravitreal injection of anti-VEGF for ROP. A total of 40 articles were reviewed after curation by the authors for relevance. Intravitreal anti-VEGF showed better ocular efficacy in zone I ROP while laser therapy had a lower recurrence rate in zone II. Comparing the two mainstay anti-VEGF agents, bevacizumab showed lower ROP recurrence rate than ranibizumab. Anti-VEGF has a higher chance in developing persistent peripheral avascularisation compared to conventional laser therapy, but a lower chance of developing high myopia. Ranibizumab has a lower systemic absorption than bevacizumab, despite having no difference in the incidence of persistent peripheral avascularisation. In conclusion, it is advised that intravitreal anti-VEGF should be used as the first-line treatment for zone I ROP while laser therapy should be the mainstay for zone II ROP owing to the different pathogenetic mechanisms. In patients with recurrence after initial anti-VEGF injection, that given ranibizumab may opt to repeat the injection while that given bevacizumab should consider supplement laser ablative treatment.
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12
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Oxygen care and treatment of retinopathy of prematurity in ocular and neurological prognosis. Sci Rep 2022; 12:341. [PMID: 35013470 PMCID: PMC8748614 DOI: 10.1038/s41598-021-04221-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/17/2021] [Indexed: 01/01/2023] Open
Abstract
This retrospective cohort study aimed to investigate the effects of neonatal oxygen care and retinopathy of prematurity (ROP) treatment on ROP-related ocular and neurological prognoses. We included premature infants treated for ROP at a tertiary referral center between January 2006 and December 2019. Demographic and clinical data were collected from electronic medical records. Odds ratios (ORs) of oxygen care- and ROP treatment-related factors were calculated for ocular and neurological comorbidities 3 years after ROP treatment, after adjusting for potential confounders. ROP requiring treatment was detected in 171 eyes (88 infants). Laser treatment for ROP (OR = 4.73, 95% confidence interval [CI] 1.64–13.63) and duration of invasive ventilation (OR = 1.02, 95% CI 1.00–1.03) were associated with an increase in ocular comorbidities, along with a history of neonatal seizure (OR = 28.29, 95% CI 5.80–137.95) and chorioamnionitis (OR = 32.13, 95% CI 5.47–188.74). No oxygen care- or ROP treatment-related factors showed significant odds for neurological comorbidities. Shorter duration of invasive oxygen supply during neonatal care (less than 49 days) and anti-vascular endothelial growth factor injection as the primary treatment for ROP are less likely to cause ocular comorbidities. No association was identified between ROP treatment modalities and the risk of neurological comorbidities.
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13
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Naravane AV, Belin PJ, Rubino S, Quiram PA. Aggressive Posterior Retinopathy of Prematurity: Long-Term Outcomes Following Intravitreal Bevacizumab. Front Pediatr 2022; 10:778585. [PMID: 35223691 PMCID: PMC8873379 DOI: 10.3389/fped.2022.778585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/17/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The purpose of this study is to review the neonatal and early childhood course of children who were treated with intravitreal bevacizumab for APROP and identify any long term limitations these children face years after treatment. METHODS This retrospective consecutive case series reviewed both ophthalmologic and pediatric medical records to determine ocular and neurologic function following treatment with a single injection of intravitreal bevacizumab (IVB) for APROP. Patient records were reviewed to identify the gestational age, average birth weight, gender, post-menstrual age (PMA) at the time of injection, regression status, rescue therapy events, final visual acuity, final refraction, ophthalmologic diagnoses and complications, neurologic diagnoses, and duration of follow up. RESULTS The study included 43 eyes from 13 male and 9 female children. The average gestational age was 24 weeks and average birth weight was 625.2 grams. The average follow-up was 4.08 years (range: 1.85-7.36 years). The average PMA at time of bevacizumab injection was 35.59 weeks. Thirty-five eyes eventually received laser photocoagulation at an average PMA of 53.17 weeks. All eyes in this study demonstrated regression without progression to retinal detachment. At last follow up, 67% (29/43) of eyes were able to discern letters or shapes, with an average visual acuity of 20/37. 16 (72%) children were diagnosed with perinatal neurological disorders. 59% (n = 13) developed chronic neurological impairment, 77% (n = 10) of whom developed neurodevelopmental delay. Several infants were diagnosed with endocrine disease or genetic syndromes. CONCLUSIONS Extreme prematurity is associated with significant morbidity. Nearly all infants (92%) who developed chronic neurologic disease were diagnosed with neurologic disease during the perinatal period. Intravitreal bevacizumab, often with adjuvant photocoagulation, led to regression without detachment in 100% of eyes, with most verbal children retaining functional vision.
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Affiliation(s)
- Ameay V Naravane
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States
| | - Peter J Belin
- VitreoRetinal Surgery, Physician Associates, Minneapolis, MN, United States
| | - Shaina Rubino
- North Carolina Retina Associates, Chapel Hill, NC, United States
| | - Polly A Quiram
- VitreoRetinal Surgery, Physician Associates, Minneapolis, MN, United States
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14
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Razak A, Kaushal M. Reply to letter to editor: Neurodevelopmental outcomes following bevacizumab treatment for retinopathy of prematurity: a systematic review and meta-analysis. J Perinatol 2021; 41:2692-2693. [PMID: 34168286 DOI: 10.1038/s41372-021-01127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Abdul Razak
- Division of Neonatology, Department of Pediatrics, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Monika Kaushal
- Division of Neonatology, Department of Pediatrics, Emirates Specialty Hospital, Dubai, United Arab Emirates
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15
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Tan H, Blasco P, Lewis T, Ostmo S, Chiang MF, Campbell JP. Neurodevelopmental outcomes in preterm infants with retinopathy of prematurity. Surv Ophthalmol 2021; 66:877-891. [PMID: 33667496 PMCID: PMC8351023 DOI: 10.1016/j.survophthal.2021.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
Over the past decade there has been a paradigm shift in the treatment of retinopathy of prematurity (ROP) with the introduction of antivascular endothelial growth factor (anti-VEGF) treatments. Anti-VEGF agents have the advantages of being easier to administer, requiring less anesthesia, having the potential for improved peripheral vision, and producing less refractive error than laser treatment. On the other hand, it is known that intravitreal administration of anti-VEGF agents lowers VEGF levels in the blood and raises the theoretical concern of intraocular anti-VEGF causing deleterious effects in other organ systems, including the brain. As a result, there has been increased attention recently on neurodevelopmental outcomes in infants treated with anti-VEGF agents. These studies should be put into context with what is known about systemic comorbidities, socioeconomic influences, and the effects of extreme prematurity itself on neurodevelopmental outcomes. We summarize what is known about neurodevelopmental outcomes in extremely preterm infants with ROP, discuss the implications for determining the neurodevelopmental status using neurodevelopmental testing as well as other indicators, and review the existing literature relating to neurodevelopmental outcomes in babies treated for ROP.
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Affiliation(s)
- Hao Tan
- Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | - Patricia Blasco
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Tamorah Lewis
- Children's Mercy Hospital, Divisions of Neonatology and Pediatric Clinical Pharmacology, University of Missouri Kansas City, Kansas City, MO, USA
| | - Susan Ostmo
- Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - John Peter Campbell
- Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.
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16
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize complications of treatment for retinopathy of prematurity (ROP) and to compare complications of laser and intravitreal antivascular endothelial growth factor (VEGF) injections. RECENT FINDINGS Poor structural outcomes and myopia are more common with laser for severe ROP than with anti-VEGF. Clinical trial data show unfavourable outcomes in 9.1-9.5% of laser treated, and 1.4-3.6% of anti-VEGF treated eyes. Additional randomized trial data show risk for very high myopia (≥-8.00D) to be 3.8 and 51.4% for zone I eyes treated with bevacizumab and laser, respectively. However, anti-VEGF may be complicated by late recurrence and is more likely to require retreatment than laser. Laser often necessitates general anaesthesia with its attendant risks, including worse short-term respiratory outcomes. Neurodevelopmental complications have been reported with anti-VEGF, but existing studies are subject to bias. SUMMARY Treatment complications are substantially different for the two modalities in common use today. In more severe cases, risk of poor structural outcome and myopia favour treatment with anti-VEGF. In less severe ROP, risk of recurrence and the need for additional treatments may favour laser. Additional data are needed to establish comparative risks of neurodevelopmental complications.
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Affiliation(s)
- Joshua M Barnett
- The Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Kumawat D, Sachan A, Shah P, Chawla R, Chandra P. Aggressive posterior retinopathy of prematurity: a review on current understanding. Eye (Lond) 2021; 35:1140-1158. [PMID: 33514899 PMCID: PMC8115681 DOI: 10.1038/s41433-021-01392-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/13/2020] [Accepted: 01/05/2021] [Indexed: 01/30/2023] Open
Abstract
A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.
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Affiliation(s)
- Devesh Kumawat
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anusha Sachan
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Shah
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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18
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Bevacizumab and neurodevelopmental outcomes of preterm infants with retinopathy of prematurity: should we still worry? J Matern Fetal Neonatal Med 2021; 35:415-422. [PMID: 33618591 DOI: 10.1080/14767058.2021.1888913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Bevacizumab may affect preterm infants' ongoing organogenesis with its antiangiogenic effects. We aimed to compare neurodevelopmental outcomes (NDO) of preterm infants treated for retinopathy of prematurity (ROP) with laser photocoagulation (LP), intravitreal bevacizumab (IVB) or both treatments, and to find out the effects of IVB on NDO. METHODS Medical records of preterm infants with ROP treatment and evaluation for NDO were retrospectively collected between 1 January 2017 and 31 June 2019. Primary outcome was Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) scores including cognitive, language, and motor scores. Secondary outcomes were neurodevelopmental impairments (NDIs) classified as the presence of any of cerebral palsy (CP), sensorineural/mixed hearing loss, visual impairment, and developmental delay with any Bayley-III score <85. Severe NDI (sNDI) was defined as presence of any of CP with a Gross Motor Function Classification Scale of 3, 4, or 5, requirement for hearing aids or cochlear implants, bilateral visual impairment or severe developmental delay with any Bayley-III score <70. RESULTS LP, IVB, and IVB + LP groups included 32, 12, and 10 patients, respectively. Patent ductus arteriosus treatment rates were as 68.7, 75, and 90% in groups, respectively (p<.05 between LP and IVB + LP groups). Grades 3 and 4 intraventricular hemorrhage (IVH) was lower in LP group than IVB group (9.4% vs. 33.4%, p<.05) while IVB + LP group had no grades 3 and 4 IVH. Other neonatal characteristics were similar (p > .05). CP was in 50%, 28%, and 0% of LP, IVB, and IVB + LP groups (p<.05). There was no difference in median Bayley-III cognitive, language, and motor scores between groups (p > .05). Moderate and severe developmental delays were similar between groups (p > .05) whereas IVB group had more moderate cognitive delay; and more severe cognitive, language, and motor delay. NDI rate was not different (59.3%, 50%, and 40% in groups, p > .05). sNDI was highest in IVB group but not statistically significant (31.2, 41.7, and 10% in groups, p > .05). Multiple logistic regression analysis showed that ROP treatment type and grades 3 and 4 IVH did not have any significant effect on NDO (p > .05). Odds of NDI was not effected by ROP treatment type (p > .05). CONCLUSIONS Patients treated with bevacizumab should be carefully monitored for neurodevelopmental problems, although the frequency of grades 3 and 4 IVH in the bevacizumab group is thought to contribute to higher rates of sNDI and Bayley-III score <70.
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Arima M, Fujii Y, Sonoda KH. Translational Research in Retinopathy of Prematurity: From Bedside to Bench and Back Again. J Clin Med 2021; 10:jcm10020331. [PMID: 33477419 PMCID: PMC7830975 DOI: 10.3390/jcm10020331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 12/11/2022] Open
Abstract
Retinopathy of prematurity (ROP), a vascular proliferative disease affecting preterm infants, is a leading cause of childhood blindness. Various studies have investigated the pathogenesis of ROP. Clinical experience indicates that oxygen levels are strongly correlated with ROP development, which led to the development of oxygen-induced retinopathy (OIR) as an animal model of ROP. OIR has been used extensively to investigate the molecular mechanisms underlying ROP and to evaluate the efficacy of new drug candidates. Large clinical trials have demonstrated the efficacy of anti-vascular endothelial growth factor (VEGF) agents to treat ROP, and anti-VEGF therapy is presently becoming the first-line treatment worldwide. Anti-VEGF therapy has advantages over conventional treatments, including being minimally invasive with a low risk of refractive error. However, long-term safety concerns and the risk of late recurrence limit this treatment. There is an unmet medical need for novel ROP therapies, which need to be addressed by safe and minimally invasive therapies. The recent progress in biotechnology has contributed greatly to translational research. In this review, we outline how basic ROP research has evolved with clinical experience and the subsequent emergence of new drugs. We discuss previous and ongoing trials and present the candidate molecules expected to become novel targets.
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Affiliation(s)
- Mitsuru Arima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan; (Y.F.); (K.-H.S.)
- Center for Clinical and Translational Research, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan
- Correspondence: ; Tel.: +81-92-642-5648
| | - Yuya Fujii
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan; (Y.F.); (K.-H.S.)
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan; (Y.F.); (K.-H.S.)
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20
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Barry GP, Yu Y, Ying GS, Tomlinson LA, Lajoie J, Fisher M, Binenbaum G. Retinal Detachment after Treatment of Retinopathy of Prematurity with Laser versus Intravitreal Anti-Vascular Endothelial Growth Factor. Ophthalmology 2020; 128:1188-1196. [PMID: 33387554 DOI: 10.1016/j.ophtha.2020.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare rates of short-term retinal detachment (RD) of infants treated for type 1 retinopathy of prematurity (ROP) with intravitreal anti-vascular endothelial growth factor (VEGF) therapy with infants treated with laser therapy. The choice between these 2 treatments remains controversial. Comparative data are limited and describe re-treatment rates rather than retinal structural outcomes predictive of long-term vision. Anti-vascular endothelial growth factor acts faster than laser therapy, which may be beneficial for more aggressive ROP. DESIGN Nonrandomized, comparative cohort study. PARTICIPANTS The study included 1167 eyes of 640 infants treated for type 1 ROP. Among these, 164 eyes received anti-VEGF therapy and 1003 eyes received laser therapy. METHODS Pretreatment and posttreatment examinations and treatments were completed by ophthalmologists with expertise in ROP. The study was a secondary analysis of data from the retrospective Postnatal Growth and Retinopathy of Prematurity Study (G-ROP) 1 study (2006-2012) and the prospective G-ROP 2 study (2015-2017). MAIN OUTCOME MEASURES Rate of RD (ROP stages 4A, 4B, or 5) within 8 weeks of initial treatment, an end point predictive of poor long-term vision. The results were stratified by postmenstrual age (PMA) at treatment as occurring before versus at or after 36 weeks and 0 days, because earlier disease may be considered more aggressive. RESULTS Among 458 eyes treated before PMA 36 weeks and 0 days, the short-term RD rate was higher after laser therapy (29/368 eyes [7.9%]) than after anti-VEGF therapy (0/90 eyes [0%]; P < 0.001). Of 709 eyes treated at or after PMA 36 weeks and 0 days, short-term RD risk did not differ between groups (laser [20/635 eyes], 3.1%; anti-VEGF [1/74 eyes], 1.4%; P = 0.27). CONCLUSIONS Anti-vascular endothelial growth factor therapy results in better short-term structural outcomes than laser therapy when type 1 ROP is treated before 36 weeks' PMA. After this age, both treatments have very low rates of short-term RD. The faster action of anti-VEGF agents likely is responsible for these findings.
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Affiliation(s)
- Gerard P Barry
- Albany Medical College, Department of Ophthalmology, Albany, New York.
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Tomlinson
- Children's Hospital of Philadelphia, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Juliann Lajoie
- Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Marilyn Fisher
- Albany Medical College, Department of Pediatrics, Albany, New York
| | - Gil Binenbaum
- Children's Hospital of Philadelphia, Department of Ophthalmology, Philadelphia, Pennsylvania
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21
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Tsai CY, Yeh PT, Tsao PN, Chung YCE, Chang YS, Lai TT. Neurodevelopmental Outcomes after Bevacizumab Treatment for Retinopathy of Prematurity: A Meta-analysis. Ophthalmology 2020; 128:877-888. [PMID: 33212122 DOI: 10.1016/j.ophtha.2020.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate neurodevelopmental outcomes after intravitreal bevacizumab (IVB) therapy in retinopathy of prematurity (ROP) infants compared with those not exposed to IVB. CLINICAL RELEVANCE The primary concern regarding IVB treatment of ROP is the potential systemic side effects, especially the risk of causing severe neurodevelopmental impairment (sNDI). Results regarding neurodevelopmental outcomes after IVB therapy are conflicting. METHODS We conducted a meta-analysis and searched PubMed, Embase, and Web of Science for related publications from inception through March 12, 2020. The eligibility criteria were as follows: comparative studies of ROP patients that (1) included IVB as a treatment arm, (2) included a control group without bevacizumab treatment, and (3) reported on at least 1 neurodevelopmental outcome, such as sNDI, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), composition scores, or cerebral palsy (CP). The primary outcome was sNDI, with the odds ratio (OR) calculated. Secondary outcomes were mean differences (MDs) for cognitive, language, and motor scores (Bayley III) and OR for CP. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS Eight studies, 6 including laser-controlled ROP infants and 2 including ROP infants not requiring treatment, were included. The weighted OR for sNDI in the IVB group was 1.39 (95% confidence interval [CI], 0.98-1.97). The weighted MDs were -1.92 (95% CI, -4.73 to 0.88), -1.32 (95% CI, -4.65 to 1.99), and -3.66 (95% CI, -6.79 to -0.54) for cognitive, language, and motor scores in Bayley III, respectively. The OR for CP was 1.20 (95% CI, 0.56-2.55). No differences were observed between the preset subgroups comprising laser-controlled ROP infants and ROP infants not requiring treatment. The current quality of evidence was rated as low (sNDI and all Bayley III scores) to very low (CP). CONCLUSIONS Risk of sNDI was not increased in ROP patients after IVB treatment. Bayley III scores were similar in the IVB and control groups, except for a minor difference in motor performance. These findings suggest that the risk of additional sNDI after IVB treatment is low. Randomized trials are warranted to provide a higher quality of evidence.
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Affiliation(s)
- Chia-Ying Tsai
- Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Research Center for Developmental Biology & Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chu Ella Chung
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Shan Chang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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22
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Seery CW, Betesh S, Guo S, Zarbin MA, Bhagat N, Wagner RS. Update on the Use of Anti-VEGF Drugs in the Treatment of Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2020; 57:351-362. [PMID: 33211892 DOI: 10.3928/01913913-20200824-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/30/2020] [Indexed: 11/20/2022]
Abstract
Retinopathy of prematurity (ROP) is one of the many significant consequences of premature birth and remains one of the leading causes of visual impairment in infants. Originally, cryotherapy was used to prevent the complications of vitreous hemorrhage and retinal detachment. Subsequently, laser photocoagulation, which is at least as effective and possibly safer than cryoretinopexy, was adopted as the primary treatment for type 1 ROP (stage 2 or 3 disease in zone II with plus disease or any stage disease in zone I with plus disease or stage 3 disease in zone I without plus disease). Laser therapy has been proven effective, and has a degree of permanence that is yet to be matched by alternative treatments, but can be associated with significant ocular side effects such as myopia. Treatment of type 1 ROP with anti-vascular endothelial growth factor (VEGF) agents seems to have fewer ocular side effects than laser ablation of the retina, particularly if used to treat type 1 ROP in zone I. However, ROP recurrence is a real threat after anti-VEGF therapy and long-term systemic side effects of this therapy remain under evaluation. This review focuses on the ophthalmic and systemic benefits and risks of anti-VEGF therapies for ROP as compared to retinal photocoagulation. Anti-VEGF therapies have dramatically altered the management of ROP and have also been shown to be beneficial with regard to the visual prognosis of patients with ROP, but patients so treated require frequent short- and long-term follow-up to detect and manage potential complications associated with this form of treatment. Such information also will allow clinicians to characterize the efficacy, side effect profile, and utility of intravitreal anti-VEGF agents for this condition. Prospective studies are needed to identify the optimum anti-VEGF drug and dose. [J Pediatr Ophthalmol Strabismus. 2020;57(6):351-362.].
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23
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Mammas IN, Spandidos DA. Retinopathy of prematurity and neonatal gut microbiome: An interview with Professor Dimitra Skondra, Associate Professor of Ophthalmology and Vitreoretinal Surgeon at The University of Chicago (USA). Exp Ther Med 2020; 20:294. [PMID: 33209138 PMCID: PMC7668155 DOI: 10.3892/etm.2020.9424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a sight-threatening disorder of the retina affecting neonates of very low birth weight and gestational age, and is characterized by the development of abnormal blood vessel growth. According to Dr Dimitra Skondra, Associate Professor of Ophthalmology and Vitreoretinal Surgeon at the University of Chicago School of Medicine in Chicago, USA, the neonatal gut microbiome may be implicated in the neoangiogenesis process in the neonatal retina and this role may be one of the missing links in the pathogenesis of ROP. The human gut microbiome consists of bacteria, viruses, protozoa and fungi, which colonize the sterile fetal intestine, and differ depending on gestational age, mode of delivery, type of neonatal feeding, the usage of antibiotics and the requirement of neonatal intensive care. To date, it has been related to multiple nutritive, metabolic and immunological functions and has been implicated in the pathogenesis of several human diseases, such as the inflammatory bowel diseases, autoimmune and neurogenerative disorders, metabolic syndrome, cardiovascular diseases and various types of malignant neoplasias. Recent research has proposed that the neonatal gut microbiome profile in high-risk neonates who develop ROP is significantly enriched with Enterobacteriacaea species several weeks prior to the diagnosis of ROP. Further research using animal models is required to prove the causative or secondary role of the microbiome composition in the development and clinical course of ROP. If this role is proven, the gut microbiome could then be a target of intervention for personalized medicine in the prevention and therapeutic management of ROP in neonates.
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Affiliation(s)
- Ioannis N Mammas
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Demetrios A Spandidos
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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24
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Frosini S, Franco F, Vicini G, Nicolosi C, Varriale G, Dani C, Virgili G, Giansanti F. Efficacy and safety of intravitreal bevacizumab for the treatment of retinopathy of prematurity: a single-center retrospective review. J Matern Fetal Neonatal Med 2020; 35:3337-3342. [PMID: 32933350 DOI: 10.1080/14767058.2020.1818214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study is to report our experience in the management of type 1 retinopathy of prematurity (ROP) or aggressive posterior retinopathy of prematurity (APROP) in premature infants, who received intravitreal bevacizumab (IVB) injections either as first-line monotherapy or as rescue therapy following laser therapy. METHODS Single-center retrospective study on 37 patients (74 eyes) affected by sight-threatening ROP that underwent treatment either with IVB alone or laser photocoagulation followed by IVB at the Neonatal Intensive Care Unit of Careggi University Hospital of Florence, between 2008 and 2015. RESULTS Seventeen patients were males (45.9%) and 20 were females (54.1%). The mean gestational age was 24 weeks and the mean birth weight was 610 g. Fifty-six eyes (75.7%) of 28 patients were diagnosed as type 1 ROP and 18 eyes (24.3%) of nine patients as APROP. Sixty-six eyes of 33 patients received IVB as first-line monotherapy, eight eyes of four patients were treated with IVB after laser photocoagulation treatment, as rescue therapy. The mean postmenstrual age at treatment was 33.9 weeks. All the patients received bilateral injections. None of the infants required repeat injections. The mean follow-up time was 59.6 months. All the patients achieved a good response to treatment, showing the regression of the proliferative phase and a complete peripheral retinal vascularization within 2 months from the injection of bevacizumab. One patient with a bilateral ROP had only a partial resolution of a vitreous hemorrhage in the left eye. The procedures were well tolerated without local or systemic adverse events during the follow-up. No infants showed recurrences. Ocular motility alterations appeared in four patients (10.8%), with the absence of stereopsis in six cases (16.20%). After treatment, spherical equivalent values in cycloplegic refraction ranged from -4.0 D to +5.0 D, with a mean value of +1.75 D. All the patients showed a normal neuropsychomotor development. CONCLUSION Our study confirms the effectiveness and safety of IVB in the treatment of ROP, both as monotherapy and rescue therapy after laser photocoagulation, according to the published literature.
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Affiliation(s)
- Saverio Frosini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Fabrizio Franco
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giulio Vicini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Gaia Varriale
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Gianni Virgili
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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25
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Zhang MH, Blair MP, Ham SA, Rodriguez SH. Two-Year Outcomes Comparing Anti-VEGF Injections to Laser for ROP Using a Commercial Claims Database. Ophthalmic Surg Lasers Imaging Retina 2020; 51:486-493. [DOI: 10.3928/23258160-20200831-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/08/2020] [Indexed: 01/09/2023]
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26
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Barry GP, Tauber KA, Greenberg S, Lajoie J, Afroze F, Oechsner H, Finucane E, Binenbaum G. A Comparison of Respiratory Outcomes after Treating Retinopathy of Prematurity with Laser Photocoagulation or Intravitreal Bevacizumab. Ophthalmol Retina 2020; 4:1202-1208. [PMID: 32512055 DOI: 10.1016/j.oret.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare respiratory outcomes after treatment of retinopathy of prematurity (ROP) between infants treated with laser therapy under general anesthesia and infants treated with intravitreal bevacizumab under bedside sedation. DESIGN Retrospective cohort study. PARTICIPANTS One hundred thirty-eight consecutive infants treated for ROP from September 2010 through September 2018 at 1 institution. METHODS Retrospective medical, procedural, and ophthalmologic data were collected, including preprocedure (baseline) and postprocedure (24 hours, 48 hours, 7 days, and 28 days) respiratory status, birth weight, gestational age, gender, ROP treatment method, postmenstrual age at treatment, and coincident nonocular procedures during anesthesia. Respiratory outcomes at 48 hours were compared between infants treated with laser therapy under general anesthesia and infants treated with intravitreal bevacizumab under local sedation using multivariate logistic regression analysis to control for potentially confounding factors. MAIN OUTCOME MEASURES Proportion of infants who had returned to their respiratory baseline by 48 hours after ROP treatment. RESULTS Return to respiratory baseline was significantly less common among 119 infants initially treated with laser therapy compared with 19 infants initially treated with bevacizumab at 24 hours (40% vs. 74%; P = 0.0115), 48 hours (53% vs. 79%; P = 0.0453), and 7 days (79% vs. 100%; P = 0.0242). In a multivariate logistic regression analysis, infants treated with laser therapy were less likely to return to respiratory baseline at 48 hours (odds ratio, 0.14; 95% confidence interval, 0.04-0.54). At 28 days, no difference was found between groups (laser, 97%; bevacizumab, 100%; P > 0.99). CONCLUSIONS Infants treated with intravitreal bevacizumab using bedside sedation returned to their preprocedure respiratory baseline faster than infants treated with laser under general anesthesia, with the differences persisting at least to 7 days or more after the procedure.
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Affiliation(s)
- Gerard P Barry
- Department of Ophthalmology, Albany Medical College, Albany, New York; Department of Pediatrics, Albany Medical College, Albany, New York.
| | - Kate A Tauber
- Department of Pediatrics, Albany Medical College, Albany, New York
| | - Scott Greenberg
- Department of Ophthalmology, Albany Medical College, Albany, New York
| | - Juliann Lajoie
- Department of Ophthalmology, Albany Medical College, Albany, New York
| | - Farzana Afroze
- Department of Anesthesia, Albany Medical College, Albany, New York
| | - Helena Oechsner
- Department of Anesthesia, Albany Medical College, Albany, New York
| | | | - Gil Binenbaum
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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27
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Rodriguez SH, Schechet SA, Shapiro MJ, Blair MP. Late visual outcomes in infants treated with primary bevacizumab for type 1 retinopathy of prematurity. J AAPOS 2020; 24:149.e1-149.e5. [PMID: 32461148 DOI: 10.1016/j.jaapos.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To describe visual acuity findings after 4 years of age in infants treated with primary bevacizumab (IVB) for type 1 retinopathy of prematurity (ROP) and to correlate structural findings on fluorescein angiography (FA) with functional outcomes. METHODS Infants born between January 2011 and January 2014 were identified by review of the medical records. Visual acuity was measured in clinic after 4 years of age. As described in the ET-ROP study, normal visual acuity was 20/40 (logMAR 0.3) or better. Examination under anesthesia with FA and prophylactic laser if necessary was recommended for all patients who received primary IVB. Vascular abnormalities were reviewed by 2 experts. RESULTS A total of 23 infants (46 eyes) completed visual acuity testing. Median age was 6 years (IQR, 4-7). Median visual acuity was logMAR 0.18 (IQR, 0-0.3). Normal vision was recorded for 39/46 (85%) eyes. Twenty-one patients (42 eyes) completed an examination under anesthesia with FA. All eyes had some peripheral capillary abnormalities (shunts, tangles, or abnormal branching); most had peripheral nonperfusion (90%) and leakage (64%). CONCLUSIONS Most eyes treated with IVB for type 1 ROP had normal visual acuity. Our results after IVB in this study compare favorably to 6-year visual outcomes in the ET-ROP study, in which 34.6% of early-treated eyes had normal visual acuity (20/40 or better). Nonetheless, a high percentage of eyes had abnormal vascular patterns on FA, which may be related to underlying ROP or to treatment. Peripheral vascular changes are common in eyes with ROP treated with IVB, but they do not preclude excellent visual acuity.
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Affiliation(s)
- Sarah Hilkert Rodriguez
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois
| | - Sidney A Schechet
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois; Elman Retina Group, Baltimore, Maryland
| | | | - Michael P Blair
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois; Retina Consultants, Ltd, Des Plaines, Illinois.
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28
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Natarajan G, Sriidhar A, Nolen T, Gantz M, Das A, Bell E, Hintz S, Bliss J, Greenberg R, Shankaran S. Authors' Response. Pediatrics 2020; 145:peds.2020-0056B. [PMID: 32234798 DOI: 10.1542/peds.2020-0056b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | | | - Abhik Das
- Statistician, Research Triangle Institute
| | | | | | - Joesph Bliss
- Neonatologist, Women and Infants Hospital of Rhode Island
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29
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Rodriguez SH, Blair MP, Shapiro MJ, Berrocal AM, Murray TG, Martinez-Castellanos MA, Hubbard GB. Neurodevelopmental Outcomes of Preterm Infants With Retinopathy of Prematurity by Treatment. Pediatrics 2020; 145:peds.2020-0056A. [PMID: 32234794 DOI: 10.1542/peds.2020-0056a] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Michael P Blair
- Retina Consults, Ltd, Des Plaines, Illinois, University of Chicago
| | - Michael J Shapiro
- Retina Consults, Ltd, Des Plaines, Illinois, University of Illinois at Chicago
| | | | - Timothy G Murray
- Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Institute
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30
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Arima M, Akiyama M, Fujiwara K, Mori Y, Inoue H, Seki E, Nakama T, Tsukamoto S, Ochiai M, Ohga S, Sonoda KH. Neurodevelopmental outcomes following intravitreal bevacizumab injection in Japanese preterm infants with type 1 retinopathy of prematurity. PLoS One 2020; 15:e0230678. [PMID: 32196539 PMCID: PMC7083318 DOI: 10.1371/journal.pone.0230678] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to evaluate neurodevelopmental outcomes in 18-month old (corrected age) preterm infants who received an intravitreal bevacizumab (IVB) injection for the treatment of type 1 retinopathy of prematurity (ROP). Methods In this ten-year retrospective study, we reviewed the medical records of patients who underwent ROP screening at Kyushu University Hospital. Among the patients who received IVB or laser photocoagulation (LPC) for the treatment of type 1 ROP, we included infants whose neurodevelopmental examination (the Kyoto Scale of Psychological Development [KSPD]) results at 18 months corrected age were available. Then, the effect of IVB on the developmental quotient (DQ) in each KSPD domain (Postural-Movement, Cognitive-Adaptive, or Language-Social domain) or the overall DQ was investigated by performing linear regression analysis. Results Out of the 513 patients reviewed, 53 were included in the study. IVB and LPC were performed for 14 and 39 patients, respectively. Administration of IVB was significantly associated with neurodevelopmental delay in the Language-Social domain (p = 0.01). The observed association remained even after adjusting for gestational age and birth weight (p = 0.03). Conclusions Administration of IVB may introduce a risk of developmental impairment of interpersonal relationships, socializations, and/or verbal abilities of preterm children. We recommended that preterm infants who received IVB undergo a neurodevelopmental reassessment during their school years or in adulthood.
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Affiliation(s)
- Mitsuru Arima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masato Akiyama
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohta Fujiwara
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yujiro Mori
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiko Seki
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahito Nakama
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoko Tsukamoto
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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31
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Shafiq A, Hillier R, Hearn R. Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP). BMJ Case Rep 2020; 13:13/3/e232359. [DOI: 10.1136/bcr-2019-232359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.
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