Abstract
PurposeThe 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.MethodsThis 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.ResultsThe 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.ConclusionsExtreme 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.
Highlights
Retinopathy of prematurity (ROP) is one of the most common causes of blindness in children
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 chronic functional limitations these children face years after treatment
Most infants (92%) who developed chronic neurologic disease were diagnosed with neurologic disease during the perinatal period. 73% (n = 16) of infants diagnosed with APROP in this study sustained frank perinatal neurologic insult
Summary
Retinopathy of prematurity (ROP) is one of the most common causes of blindness in children. It is a vasoproliferative disorder that occurs in two stages. Preterm birth exposes infants to a relative hyperoxic environment. Hyperoxia decreases production of growth factors including vascular endothelial growth factor (VEGF) in the retina, leading to delayed vascular maturation. As the retina matures, the increased metabolic activity overwhelms the oxygenation supply from the existing vascular supply resulting in retinal ischemia. This in turn results in increased production of VEGF leading to abnormal neovascular proliferation [1, 2]
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