ASRS 2023: Long-term cognitive outcomes not negatively impacted by intravitreal bevacizumab for ROP

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Reviewed by Wei-Chi Wu, MD, PhD

Taiwanese clinicians found that intravitreal bevacizumab (IVB) (Avastin, Genentech Inc/Roche) did not significantly affect cognitive outcomes over the long term in patients with retinopathy of prematurity (ROP) compared to patients who had been treated with laser photocoagulation treatment or both.

Senior author Wei-Chi Wu, MD, PhD, reported the results of a long-term study of children with ROP treated with IVB at the 2023 annual meeting of the American Society of Retina Specialists in Seattle. He is from the Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

The standard treatment for ROP has been application of laser photocoagulation to the avascular retina to reduce vascular endothelial growth factor (VEGF) in patients with phase II ROP. IVB was ushered in to treat ROP slightly over a decade ago and demonstrated neutralization of VEGF in the vitreous and a better structural outcome for patients with zone 1 stage III+ ROP. Clinicians have seen an increased use of IVB over time and laser is still used in these patients.

However, a question remains about the potential for neurodevelopmental impairment in children with ROP treated with IVB because any detrimental effects of IVB may not be recognized at an early age, which underscores the importance of following these children over time.

Prospective cohort study

The study population included 277 children born in Taiwan and enrolled at a mean age of 8 years. The study also included a group of children who did not have ROP. The study ran from 2019 to 2021.

The patients were stratified into 4 groups: full-term, premature without ROP, untreated ROP, and treated ROP.

The main outcome measure was the Full-Scale Intelligent Quotient (FIQ) calculated using the Wechsler Intelligence Scale for Children, Fourth Edition1 (WISC-IV), Wu explained. The WISC-IV includes a cognitive assessment test in children from 6 to 16 years old in which 15 domains evaluate verbal comprehension, perceptual reasoning, working memory, processing speed, and fluid reasoning.

Primary findings

The data analysis showed that the patients with ROP, who were a mean age of 7.8 years, had significantly lower FIQ scores and percentile compared to full-term patients.

No abnormal neurodevelopmental outcomes were seen in patients with ROP who had been treated previously with intravitreal injections compared to laser treatment.

No significant difference was seen in the FIQ scores and percentile among patients who received different treatments.

The gestational age and the logarithm of the minimum angle of resolution visual acuity (logMARVA) were two factors significantly associated with the FIQ scores and FIQ percentiles. That is, lower gestational age and higher logMAR VA (lower vision) were associated with lower FIQ scores and percentile.

“Neurodevelopment outcome is an important factor when choosing a treatment for premature infants with ROP because it is related to the safety of a treatment. Apart from the most well-known function of a regulator of physiological and pathological angiogenesis, VEGF had been linked to functions such as neurodevelopment, axonal growth, neuroplasticity, and neurogenesis. Our data have provided an important reference for using anti-VEGF in ROP treatment because of the concern about systemic VEGF suppression leading to worse neurodevelopment following intravitreal injection. It suggests anti-VEGF may be a well-tolerated treatment for these high-risk premature patients with ROP requirement treatment,” Dr. Wu concluded.

Wei-Chi Wu, MD, PhD

E: weichi666@gmail.com

Wu is from the Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan. He has no financial interest in this subject matter.

Reference:

1. Wechsler D. (2003). Wechsler Intelligence Scale for Children, 4th Ed. 2003; San Antonio, TX: PsychCorp.