Intravitreal injections for ROP prove safe, effective in many cases

Intraocular anti-VEGF injections for retinopathy of prematurity (ROP) are safe as demonstrated by practice patterns in various settings inside and outside of the United States, but additional therapy may be required, according to Dr Luis Acaba-Berrocal of the Illinois Eye and Ear Infirmary in Chicago, United States.

Given the dearth of real-world data on this topic, Dr Acaba-Berrocal and his colleagues conducted a multicentre, retrospective, consecutive study of infants with ROP who had been treated with intravitreal anti-VEGF injections between 2008 and 2020. The study was conducted at 17 US and international sites.

The goal was to provide clinicians with guidance based on practice patterns regarding the administration of intravitreal injections to treat ROP and outcomes data regarding re-treatments and complications.

Study design

For inclusion in the study, the investigators identified 1,124 eyes that had been treated with anti-VEGF injections for ROP. The study patients’ average birth weight was 791 g (95% confidence interval [CI] 771.9–811.3 g), and the average gestational age at birth was 25.7 weeks. The patients were an average of 36.6 weeks after conception at the time of treatment.

A few different anti-VEGF therapies were used to treat the patients. These included bevacizumab (Avastin, Genentech) at a dose of 0.625 mg in 72.1%, ranibizumab (Lucentis, Genentech) at a dose of 0.15 mg in 27.8% and aflibercept (Eylea, Regeneron Pharmaceuticals) in 0.2%.

Most patients (88.1%) were treated with anti-VEGF drugs bilaterally. Nearly three-quarters of patients (67.8%) received antibiotics after the injections. A 32-gauge short needle was used in 39.3% of cases.

Key findings

Regarding the necessity for re-treatments, Dr Acaba-Berrocal reported that 38% of patients required subsequent laser therapy, which was performed at an average of 134 days (95% CI 119–149 days) following the intravitreal injections; 8% needed another injection and the average time to this re-treatment was 59 days (95% CI 51–68 days). More than half of the patients (54%) did not require a re-treatment.

Very few complications developed in this patient population. Specifically, vitreous haemorrhages developed in 0.5% of patients and cataracts developed in 0.2%. There were no cases of retinal detachment or endophthalmitis.

The investigators pointed out that a variety of practice patterns and settings were seen both in the US and internationally. In these real-world settings, there were a significant number of treatments performed after the initial anti-VEGF injections were administered. They also found that follow-up laser treatments were the preferred method of re-treatment, rather than administration of additional intravitreal anti-VEGF injections.

Based on these outcomes, the investigators concluded that anti-VEGF injections to treat infants with ROP are safe and have a very low complication rate in the multiple practice patterns observed. The investigators noted, however, that subsequent treatment may be required.

Luis Acaba-Berrocal, MD

E: lacaba2@uic.edu

This article is adapted from Dr Acaba-Berrocal’s presentation at the American Academy of Ophthalmology 2021 annual meeting. He has no financial interest in this subject matter.