First Author: S.Kimyon TURKEY
Co Author(s): A. Mete
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Vascular endothelial growth factor (VEGF) inhibitors are now being used for the treatment of retinopathy of prematurity (ROP). Our aim is to compare the effects and complications of bevacizumab, ranibizumab and laser photocoagulation for the treatment of ROP.
This is a retrospective study, conducted in Gaziantep University Department of Ophthalmology, Turkey.
We evaluated the files of the patients who were treated for ROP in this retrospective study. Gestational age, birth weight, time spent in a neonatal incubator, zone and stage of ROP before treatment, type of the treatment, time needed for improvement were recorded. Patients with missing data or follow ups were excluded from the study. Patients were examined when they were one year-old and their refrection, intraocular pressure, axial lenght and any complication were noted. There data were compared between laser photocoagulation (LP), bevacizumab, ranibizumab or combined treatment (anti-VEGF and laser) groups.
Files of 77 infants were examined. 147 eyes of these patients were treated for ROP. 60 eyes were treated with LP, 58 eyes with bevacizumab, 18 eyes with ranibizumab and 11 eyes with both an anti-VEGF and LP. There wasn’t any significant difference regarding the gestational age and birth weight between groups. The mean refractive error of the laser, bevacizumab, ranibizumab and combined group was -3.15±2.87; -1.70±2.01; 1.78±2.40 and -1.04±2.60 diopters respectively. There was significant myopic refraction in patients treated with LP. There was also a statistically significant difference between bevacizumab and ranibizumab groups. Mean axial lengths were 20.90±0.87 mm in the laser group, 21,08±0,98 mm in bevacizumab group, 18.92±0.48 mm in ranibizumab group and 20.75±1.64 mm in combined group. There was significant difference between bevacizumab and ranibizumab groups regarding the axial length. Retinal vascularization was not completed in 23 eyes treated with bevacizumab and in 7 eyes treated with ranibizumab. Two eyes in bevacizumab group and 1 eye in laser group developed stage 5 ROP. Macular traction occured in three eyes in laser group and 2 eyes in combined group. One patient treated with bevacizumab died because of respiratory failure.
All treatment modalities were effective for type 1 ROP treatment in our study. Macular traction only occured in eyes treated with laser photocoagulation. Ten eyes which were treated with bevacizumab and 1 eye treated with ranibizumab showed progression and needed laser photocoagulation (combined group). Although the role of bevacizumab was not proven, death of one patient in the bevacizumab group raises suspicion about the safety of this treatment. There wasn’t any systemic complication in the ranibizumab group. Laser photocoagulation increased the risk of myopia. There was also a significant difference between bevacizumab and ranibizumab groups regarding the refractive error and axial length in our study. This may be because of the longer duration of bevacizumab in the vitreous. Further studies are required to fully understand the differences between bevacizumab and ranibizumab.