Retinopathy of Prematurity and Intravitreal Bevacizumab Treatment: Single Center Experience

Year 2023, Volume: 49 Issue: 1, 17 - 21, 09.06.2023

Bayram Ali Dorum , Zeynep Şenocak Mustafa Yaşar Didem Demirağ

https://doi.org/10.32708/uutfd.1161416

Abstract

In this study, the frequency of retinopathy of prematurity (ROP) in premature infants born in a tertiary state hospital, and the characteristics of infants with ROP and requiring treatment were investigated. In addition, experiences regarding the treatment and follow-up processes applied for RROP were shared. In the study, the data of premature babies born before 35 weeks were analyzed retrospectively. The data of infants with and without treatment indication among infants who developed ROP were compared. In the study, the data of 112 infants who were treated in our unit over two years and followed up for ROP were evaluated. The mean gestational age of the babies was 28.37±2.55 weeks, and the mean birth weight was 1171.66±405.17 grams. ROP was detected in 44 (39.2%) of the babies. Among infants who developed ROP, those who received treatment indication (n: 10) were infants with lower birth weight and higher inotrope requirement (p<0.05). ROP was not detected in premature babies born at 30 weeks or more. The highest birth week of babies who developed severe ROP was 27. As a treatment, intravitreal bevacizumab injection was successfully applied. The age of detection of ROP is advancing towards lower weeks in our country. Intravitreal bevacizumab is an effective and short-term safe treatment method that can be applied at the bedside.

Keywords

Bevacizumab, retinopathy of prematurity, vascular endothelial growth factor

Prematüre Retinopatisi ve İntravitreal Bevacizumab Tedavisi: Tek Merkez Deneyimi

Abstract

Bu çalışmanın amacı üçüncü basamak bir devlet hastanesinde doğan prematüre bebeklerdeki prematüre retinopatisi (ROP) sıklığı, ROP saptanan ve tedavi gereken bebeklerin özellikleri, uygulanan tedavi ve takip süreçleri ile ilgili deneyimlerin paylaşılmasıdır. Çalışmada 35 haftadan erken doğan prematüre bebeklerin verileri retrospektif olarak incelendi. ROP gelişen bebekler içinde tedavi endikasyonu konan ve konmayan bebeklerin verileri karşılaştırıldı. Çalışmada iki yıllık süre içerisinde ünitemizde tedavi görmüş ve ROP açısından takipleri tamamlanmış olan, 112 bebeğin verileri değerlendirildi. Bebeklerin ortalama gestasyonel yaşı 28,37±2,55 hafta, ortalama doğum ağırlığı 1171,66±405,17 gram idi. Bebeklerin 44 tanesinde (%39,2) ROP saptandı. ROP gelişen bebekler arasında tedavi endikasyonu alanlar (n: 10) daha düşük doğum ağırlığı ve daha yüksek oranda inotrop gereksinimi olan bebeklerdi (p<0.05). Otuz hafta ve üzerinde doğan prematüre bebeklerde ROP saptanmadı. Ciddi ROP gelişen bebeklerin en yüksek doğum haftası 27 idi. Tedavi olarak intravitreal bevacizumab enjeksiyonu başarılı ile uygulandı. Sonuç olarak ROP saptanma yaşı ülkemizde daha düşük haftalara doğru gerilemektedir. İntravitreal bevacizumab hasta başında uygulanabilen etkin ve kısa dönemde güvenilir bir tedavi yöntemidir.

Keywords

Bevacizumab, prematüre retinopatisi, vasküler entotelyal büyüme faktörü

References

• 1. Sun H, Dong Y, Liu Y, et al. Using ROPScore and CHOP ROP for early prediction of retinopathy of prematurity in a Chinese population. Ital J Pediatr. 2021;47(1):39.
• 2. Adams GGW. ROP in Asia. Eye (Lond). 2020;34(4):607–608.
• 3. Bas AY, Demirel N, Koc E, et al. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): A prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol. 2018;102(12):1711–1716.
• 4. Fierson WM, American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142(6) :e20183061. doi: 10.1542/peds.2018-3061.
• 5. Koç E, Yağmur Baş A, Özdek Ş, Ovalı F, Başmak H. Turkish neonatal and Turkish ophthalmology societies consensus guideline on the retinopathy of prematurity. Turk Pediatri Ars. 2018;53:S151–160.
• 6. Chiang MF, Quinn GE, Fielder AR, et al. International Classification of Retinopathy of Prematurity, Third Edition. Ophthalmology. 2021;128(10):e51–68.
• 7. Rajan RP, Kohli P, Babu N, et al. Treatment of retinopathy of prematurity (ROP) outside International Classification of ROP (ICROP) guidelines. Graefes Arch Clin Exp Ophthalmol. 2020;258(6):1205–1210.
• 8. Sankar MJ, Sankar J, Chandra P. Anti-vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity. Cochrane Database Syst Rev. 2018;8(1): CD009734.
• 9. Stahl A, Lepore D, Fielder A, et al. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial. Lancet. 2019;394(10208):1551–1559.
• 10. Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019;115(4):432–450.
• 11. European Medicines Agency (EMA). Report on the Expert Meeting on Neonatal and Paediatric Sepsis. London:; 2010. https://www.ema.europa.eu/en/documents/report/report-expert-meeting-neonatal-paediatric-sepsis_en.pdf
• 12. Jobe AH, Bancalari E. Bronchopulmonary Dysplasia. American Journal of Respiratory and Critical Care Medicine. 2001;163:1723–9.
• 13. Walsh MC, Kliegman RM, D M. Necrotizing Enterocolitis: Treatment Based on Staging Critera. Pediatr Clin North Am. 1986;33:179–201.
• 14. Inder TE Perlman JM, Volpe JJ. Preterm Intraventricular Hemorrha- ge/Posthemorrhagic Hydrocephalus. In: Volpe’s Neurology of the Newborn, 6th, Volpe JJ (Ed), Elsevier, Philadelphia 2018:637-98.
• 15. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited: An international committee for the classification of retinopathy of prematurity. Arch Ophthalmol. 2005;123(7):991–999.
• 16. Good WV, Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004;102:233–50.
• 17. Thomas D, Madathil S, Thukral A, et al. Diagnostic Accuracy of WINROP, CHOP-ROP and ROPScore in Detecting Type 1 Retinopathy of Prematurity. Indian Pediatr. 2021;58(10):915–921.
• 18. Higgins RD. Oxygen Saturation and Retinopathy of Prematurity. Clin Perinatol. 2019;46(3):593–599.
• 19. Gomaa NAS, Helmy YAH, Maher S, et al. Clinical characteristics of preterm neonates with aggressive posterior retinopathy of prematurity. Clin Ophthalmol. 2021;15:2263–2277.
• 20. Hwang CK, Hubbard GB, Hutchinson AK, Lamber SR. Outcomes after Intravitreal Bevacizumab versus Laser Photocoagulation for Retinopathy of Prematurity: A 5-Year Retrospective Analysis. Ophthalmology. 2015;122(5):1008–1015.
• 21. Dorum BA, Yılmaz CC, Köksal N, et al. The role of serial measurements of serum insulin-like growth factor 1 levels in the development of retinopathy of prematurity. Turk pediatri ars. 2017;52(1):10–4.
• 22. Wallace D, Dean TW, Hartnett ME, et al. A Dosing Study of Bevacizumab for ROP: Late Recurrences and Additional Treatments. Ophthalmology. 2018;125(12):1961-1966.