Supplemental Laser for Eyes Treated with Bevacizumab Monotherapy in Severe Retinopathy of Prematurity

To evaluate the safety and efficacy of a deferred laser treatment after intravitreal bevacizumab (IVB) monotherapy in cases of severe retinopathy of prematurity (ROP) infants. Retrospective study. Infants diagnosed with severe ROP, i.e., aggressive posterior ROP (APROP) and ROP in zone 1 and zone 2 posterior with plus disease. Infants diagnosed with severe ROP received immediate IVB. Laser photocoagulation was done, at which time anterior growth of the vessels was arrested. This was seen clinically either with the formation of a demarcation line or when no growth of vessels was seen subjectively on 2 subsequent clinical examinations over a period of 2 weeks. Primary outcome measures were the ability to prevent ROP recurrence and the anatomic outcome at the last follow-up visit. Of the 3792 patients screened, 14 patients (28 eyes) were diagnosed with APROP and 15 patients (30 eyes) were diagnosed with ROP in zone 1 and zone 2 posterior with plus disease. Neovascularization of the iris was noted in 4 eyes of 3 patients. The mean postmenstrual age at which IVB was given was 35.0±2.4 weeks (range, 28–40 weeks). ROP along with neovascularization of the iris regressed in all eyes at the next follow-up at 2 weeks. Recurrence of ROP was noted in 4 eyes of 2 patients (6.8%). Both patients had APROP initially. The adjusted age at which recurrence occurred was 35.0±2.8 weeks (range, 33–37 weeks) and laser treatment was done at the adjusted age of 44.0±4.2 weeks. The mean duration between IVB and laser was 9.0±7.1 weeks (range, 4–14 weeks). The mean follow-up was 13.1±1.5 months (range, 12–18 months). None of the eyes developed recurrence after laser treatment in the 1-year follow-up period. None of the patients developed an unfavorable anatomic outcome. In our small series, using our treatment protocol, devastating complications and associated blindness related to reactivation of the disease were not seen. Our proposed protocol of IVB monotherapy with deferred laser treatment can be used in severe ROP patients with poor compliance.