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| |  Retinal Damage May Not Be the Cause of High Myopia in Neonates With Retinopathy of Prematurity: Presented at ARVO By Cameron Johnston FT. LAUDERDALE, Fla -- May 12, 2009 -- Most premature babies with retinopathy of prematurity (ROP) develop high myopia by their third year, but it might not be due to any pathology of the retina. These infants become myopic at the same rate whether they are treated with cryotherapy, laser photocoagulation, or intravitreal bevacizumab, researchers stated here at the Association for Research in Vision and Ophthalmology (ARVO) 2009 Annual Meeting. According to Maria Martinez-Castellanos, MD, Mexican Association to Prevent Blindness (APEC, Asociación Para Evitar la Ceguera), bevacizumab has been used to treat ROP in Mexico since 2005. She presented longer-term follow-up data on neonates who were treated with the anti- vascular endothelial growth factor receptor drug in a poster presentation on May 5. ROP does not develop in all premature babies, Dr. Martinez-Castellanos explained, but it usually leads to profound visual impairment, and in some cases total blindness. "Even at stage 4, you are looking at very profound visual impairment," Dr. Martinez-Castellanos told DocGuide. Dr. Martinez-Castellanos and colleagues examined 13 children with ROP, all born at very low birth weights, and between 27 to 30 weeks gestation. Each child received a single injection of bevacizumab 0.05 mg at an average age of 6 to 8 weeks. The injection was around 1/25 the dose normally used in adults. Of the babies, 61.5% were myopic, with a mean spherical equivalent (SE) of -2.33 dioptres. High myopia was present in 15%, with a mean SE of -5.12 dioptres. Eyes that were stage 4a had a mean SE of -1.25 dioptres. Dr. Martinez-Castellanos said she would have expected a similar degree of myopia to occur in children who were treated with cryotherapy or laser photocoagulation. In fact, past studies have shown that premature infants who do not develop ROP are just as likely to be visually impaired as those who were treated with either of these older modalities. In this review, although more than three-quarters of the babies had significant visual impairment, it was not caused by abnormalities in the retina. Nor, she said, was the visual impairment caused by abnormal axial length or lens thickness. She speculated that the impairment could, perhaps, be caused by flattening of the cornea, and indeed, many of these children did show anterior chamber depth that was shallower than normal. The flattening of the cornea, she said, was not caused by the bevacizumab use, but resulted from the prematurity. "Even after treatment with bevacizumab, or laser or cryotherapy, they are myopic because of the prematurity. The bevacizumab did not modify that. Either way they were going to be myopic," she said. She said she would recommend continuing to treat premature babies who have ROP with bevacizumab. "Myopia can be treated with glasses, but we're trying to preserve the retina," she said. Also, treating premature infants with a single intravitreal injection is much easier than trying to treat them with surgery or laser photocoagulation. Dr. Martinez-Castellanos said she believes that this is the largest single group of children in the world to have their ROP treated with bevacizumab. It is very important to continue tracking these children to monitor any long-term results from bevacizumab use.
[Presentation title: Antiangiogenic Therapy With Bevacizumab in Retinopathy of Prematurity: Refractive Outcomes in a Three-Years Follow Up. Abstract 3156-A503]
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