Re: Freedman et al: Low- and very low-dose bevacizumab for retinopathy of prematurity: reactivations, additional treatments, and 12-month outcomes (Ophthalmology. 2022;129:1120–1128)

Abstract

We read the article by Freedman et al1Freedman S.F. Hercinovic A. Wallace D.K. et al.Low- and very low-dose bevacizumab for retinopathy of prematurity: reactivations, additional treatments, and 12-month outcomes.Ophthalmology. 2022; 129: 1120-1128Abstract Full Text Full Text PDF Scopus (0) Google Scholar with joy and great interest. Traditionally, the accepted treatment for retinopathy of prematurity (ROP) is laser photocoagulation.2Early Treatment for Retinopathy of Prematurity Cooperative GroupRevised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial.Arch Ophthalmol. 2003; 121: 1684-1694Crossref PubMed Scopus (1530) Google Scholar Moreover, photocoagulation takes a longer time and has late complications such as loss of peripheral vision field, strabismus, anisometropia, and high myopia.3Wang J. Ren X. Shen L. et al.Development of refractive error in individual children with regressed retinopathy of prematurity.Invest Ophthalmol Vis Sci. 2013; 54: 6018-6024Crossref PubMed Scopus (56) Google Scholar Bevacizumab is increasingly being used for the treatment of patients with ROP. This article assessed the longitudinal outcomes of low-dose (0.25–0.031 mg) versus very low-dose (0.016–0.002 mg) intravitreal bevacizumab (IVB) in infants with type 1 ROP.1Freedman S.F. Hercinovic A. Wallace D.K. et al.Low- and very low-dose bevacizumab for retinopathy of prematurity: reactivations, additional treatments, and 12-month outcomes.Ophthalmology. 2022; 129: 1120-1128Abstract Full Text Full Text PDF Scopus (0) Google Scholar The authors conclude that low-dose and very low-dose IVB cohorts exhibited similar outcomes.1Freedman S.F. Hercinovic A. Wallace D.K. et al.Low- and very low-dose bevacizumab for retinopathy of prematurity: reactivations, additional treatments, and 12-month outcomes.Ophthalmology. 2022; 129: 1120-1128Abstract Full Text Full Text PDF Scopus (0) Google Scholar However, the very low-dose IVB group was at greater risk of sooner ROP reactivation than the low-dose IVB group. The limitations of the present study, which introduces the potential for bias, was the nonstandardized approach to follow-up treatment and the treatment of the fellow eye. The fellow eye was treated with bevacizumab, which could improve the ROP in the study eye. Additionally, the 0.002 mg used in the study is a very low-dose level for dispensing accuracy at the hospital pharmacy and with high possibility of losing the medication during the intravitreal injection technique. The main concern of bevacizumab injection continues to be the unknown long-term effects of systemic absorption. To the best of our knowledge, still there is no defined treatment protocol for IVB in ROP, and further studies are required. Low- and Very Low-Dose Bevacizumab for Retinopathy of Prematurity: Reactivations, Additional Treatments, and 12-Month OutcomesOphthalmologyVol. 129Issue 10PreviewLow-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants. Full-Text PDF ReplyOphthalmologyPreviewWe appreciate the opportunity to respond to the comments of Dr Asensio-Sanchez regarding our article. The use of intravitreal bevacizumab for type 1 retinopathy of prematurity (ROP) has expanded our options and perhaps improved outcomes from this disease. As Dr Asensio-Sanchez points out, our data suggested a trend toward earlier reactivation of ROP with lower doses. In our study, we performed a time-to-event analysis that showed the restricted mean time to reactivation was shorter with very low doses than with low doses of bevacizumab. Full-Text PDF