Low-, very low-dose bevacizumab for retinopathy of prematurity yield good outcomes

Use of low- and very low-dose intravitreal bevacizumab (IVB) as initial treatment for type 1 retinopathy of prematurity (ROP) leads to satisfactory retinal structural outcomes, reports a study, noting that many eyes have received additional treatment.

This multicentre study included a cohort of 120 infants with type 1 ROP in at least one eye from two sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the other eye also received one dose level higher of IVB if also type 1.

Clinical management, including all additional treatments, was at investigator discretion after primary success or failure at 4 weeks.

A total of 113 study and 98 fellow eyes were analysed, of which 62 (55 percent) and 55 (56 percent) received additional treatment, respectively. Among study eyes, 31 (27 percent) received additional ROP treatment, and 31 (27 percent) had prophylactic laser therapy for persistent avascular retina.

There was no trend seen toward an increased risk of additional ROP treatment associated with initial IVB doses. However, time to reactivation in study eyes was shorter in those treated with very-low dose IVB (mean 76.4 days) than in eyes receiving low-dose IVB (mean 85.7 days).

At 12 months, poor retinal outcomes (3 percent) and anterior segment abnormalities (5 percent) were scarce, while optic atrophy occurred in 10 percent; median refraction was mildly myopic (‒0.31 diopter). In addition, 29 percent of infants had strabismus.

“The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses,” the investigators said.