P1.178: Visual and Neurodevelopmental Outcomes Following Bevacizumab Therapy for Severe Retinopathy of Prematurity

Background: Bevacizumab (Avastin) is an anti-VEGF medication that can be used as an intravitreal injection for the treatment of Retinopathy of Prematurity (ROP). When compared to laser photocoagulation, Avastin therapy (AT) has multiple advantages, including rapid effect, cost effectiveness, and ease of bedside treatment. However, because of weeks-to-months of reduced serum VEGF levels, concern for long-term neurodevelopmental delays (NDD) and visual outcomes (VO) exist, resulting in slow implementation as first-line treatment. Our objective was to analyze NDD and VO in patients receiving AT therapy for ROP over a decade at our single institution.

Methods: Data were collected via retrospective chart review of patients screened, treated and followed for ROP at MUSC. Patients were grouped into three categories based on the therapy they received: 1) Avastin therapy (AT), 2) laser photocoagulation (LC) and 3) neither treatment (NT). Primary NDD included early deficits (18 to 24 months) and later neurobehavior issues (NBI) such as ASD and ADHD (diagnosed between 2.5 to 5 years). NDD was defined as Developmental Quotient (DQ) < 80 in 2 or more areas by Capute scales for Cognition (CAT) and language (CLAMS) and modified Peabody for Gross Motor (GM). To measure NBI, ASD and ADHD were confirmed by standardized tests. Neonatal variables included sex, race, birth weight, gestational age, SGA, weight gain per day, length of stay, length of intubation, and co-morbid conditions PDA, IVH, PVL, or NEC.

Results: In this single center study, data were collected for 93 patients (2008-2020) with groups A) AT 51 (54.8%), B) LC 1O (10.7%), and C) NT 32 (34.4%). The frequency of patients with early NDD was 31 (60.8%), 6 (75.0%), and 16 (51.6%), respectively. The incidence of ASD patients was 11 (21.6%), 3 (30.0%), and 6 (19.4%). The frequency of patients with ADHD was 14 (27.5%), 2 (20.0%), and 9 (29.0%). In chi-square and fisher's exact test analysis, there was no significant difference when controlled for various patient variables among the 3 groups. For visual outcomes, the frequency of moderate to severe myopia in either eye was 8 (33.3%), 4 (66.7%), and 3 (30.0%). The frequency of moderate to severe hyperopia in either eye was 4 (23.5%), 0 (0.0%), and 1 (9.1%). In chi-square analysis, various patient variables were not statically associated with hyperopia or myopia. There were also no significant differences in visual or neurodevelopmental outcomes when comparing patients who received the initial dose of Avastin used, 0.625 mg, and the eventual decreased dose, 0.2 mg.

Conclusion: Our data suggest that there are no important clinical differences in early NDD, later NBI including ASD and ADHD, or refractive error outcome in infants receiving intravitreal Avastin for severe ROP compared with similar infants receiving laser photocoagulation or not requiring ROP treatment.