COMMENTARY

Intravitreal Bevacizumab Injections for Retinopathy of Prematurity: 5 Years of Follow-up

Yousef J. Cruz-Inigo; Sophie J. Bakri, MD

Disclosures

January 23, 2013

Long-term Effect of Antiangiogenic Therapy for Retinopathy of Prematurity up to 5 Years of Follow-up

Martínez-Castellanos MA, Schwartz S, Hernández-Rojas ML, et al
Retina. 2012 Oct 24 [Epub ahead of print]

Study Summary

Martínez-Castellanos and colleagues evaluated ocular function, neurodevelopment, and growth in infants treated with intravitreal bevacizumab injections for retinopathy of prematurity (ROP) during a 5-year period.

This prospective, interventional, noncomparative case study was conducted in Mexico City. Eighteen eyes from 13 patients (birth weight ≤ 1600 g and gestational age ≤ 32 weeks) were injected with 0.05 mL (1.25 mg) of bevacizumab. Patients were included only if they had a diagnosis of high-risk prethreshold or threshold ROP, or inadequate visualization of the retina but with neovascularization (rubeosis iridis).

The investigators found initial regression of neovascularization in all patients. Except in 2 operated eyes, the remaining 16 eyes exhibited a gradual and consistent increase in grating acuity with a median vision of 20/25. Twelve patients achieved satisfactory neurodevelopment and growth. Only 1 patient, with concomitant pulmonary dysplasia and grade 3 intraventricular hemorrhage, showed combined neurodevelopmental and growth delay.

Viewpoint

This is the first study to address the long-term visual outcome and systemic safety profile of bevacizumab. These findings suggest that the drug may benefit infants whose vision is threatened by ROP by preserving ocular function while avoiding the risks associated with general anesthesia or sedation. Although the findings are promising, ophthalmologists should interpret these results with caution because follow-up was limited to 5 years and the sample size was too small to reflect all potential side effects of antiangiogenic therapy. On the other hand, conventional laser treatment has negligible systemic side effects and improved vision has consistently been reported following therapy during the early stages of ROP. As a result, long-term large prospective, controlled, randomized trials are needed to determine the safety and efficacy of bevacizumab before ophthalmologists consider changing the current standard of care to angiogenesis inhibitors, which can have permanent sequelae in this vulnerable patient population.

Abstract

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