Morphological outcome and indication for laser following intravitreal bevacizumab monotherapy for posterior retinopathy of prematurity

The purpose of this study is to determine the natural course of retinal vascular development and recurrence requiring laser in eyes receiving intravitreal bevacizumab (IVB) for posterior retinopathy of prematurity (ROP). Data of babies receiving IVB for posterior ROP was retrospectively analyzed. Birth weight, gestational age (GA) and post-menstrual age (PMA) at injection, need for laser, retinal maturation, and their timing were recorded. The study included 63 eyes of 32 babies, born at a median GA of 31 (IQR 29-32) weeks, and birth weight 1410 (1280-1697.5) g. Aggressive posterior ROP was seen in 36 (57%) eyes and staged ROP in 27 (43%). IVB was injected at a median PMA of 36 (34.5-37) weeks. Complete retinal vascularization was seen in 33 (52.4%) at a median PMA of 52 (47-60) weeks, prophylactic laser was needed in 17 (27%) at 61 (55.5-63) weeks, and only 13 (20.6%) eyes had recurrence needing treatment laser, at 42 (39-57) weeks respectively. Babies requiring laser had a significantly lower birth weight (p = 0.033) and received injection earlier (p = 0.08). Retinal vascular development progresses with IVB monotherapy with 21% of eyes developing recurrence that requires laser in this subset of Indian babies. Following IVB, monotherapy laser can be selectively performed only in cases with recurrence or failure to mature.