Presenter Status
Student
Abstract Type
Research
Primary Mentor
Katherine Brown, MD
Start Date
12-5-2025 11:30 AM
End Date
12-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Retinopathy of prematurity (ROP) is an eye disease that affects very premature infants and causes blindness. Treatment for ROP consists of anti-VEGF intravitreal injections (e.g., bevacizumab), laser therapy, and cryotherapy. The concern of anti-VEGF intravitreal injections is systemic toxicity and potential detrimental effects on these developing infants. In research trials, doses as low as 0.031 mg of bevacizumab have been shown to be effective in treating ROP. However, in clinical practice, the most common doses used are 0.125-0.25 mg.
Objectives/Goal: At CMKC, 0.075 mg doses of bevacizumab have been used to treat Type 1 ROP since 2022. We aim to share the outcomes of treating type 1 ROP using low-dose bevacizumab injections. These results may impact how we and other physicians treat ROP in the future.
Methods/Design: Between March 2022 and November 2024, 39 infants were treated for Type 1 ROP with intravitreal bevacizumab at CMKC. We excluded seven patients: two who were lost to follow up, three who transferred care prior to completion of ROP examination, and two actively being followed post-intravitreal injection. In total, 32 patient outcomes were included in our analyses.
Results: Four patients received a second intravitreal injection in one or both eyes, and one patient received a third injection in one eye for recurrent disease. Additionally, panretinal laser photocoagulation with an 810nm wavelength diode laser was used to treat recurrent disease in anterior zone 2 or zone 3. 25 patients (78.1%) received laser treatment for recurrent disease. Two patients (6.25%) received laser treatment for persistent avascular retina (PAR). Seven patients (21.9%) achieved complete vascularization after 0.075 mg intravitreal injection and did not require laser. Of note, one patient experienced a late retinal detachment, at 89 weeks GA. This was 34 weeks after the patient’s last treatment and 26 weeks after the exam confirming complete regression of ROP. Importantly, this patient was the only to receive a third bevacizumab injection in addition to two rounds of laser in the eye of interest due to severe and recalcitrant ROP.
Conclusions: This study supports lower dose intravitreal bevacizumab in clinical practice. Lower doses of bevacizumab reduce the systemic load of the drug and thus potential side effects. One difference with the lower dose of bevacizumab is the higher potential for reactivation of ROP. However, this lower dose allows for the flexibility to treat patients with a second injection, rather than laser, with the total anti-VEGF administered equal to one standard injection. Head-to-head trials comparing low and standard doses should be conducted.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Medical Pharmacology Commons, Ophthalmology Commons, Pediatrics Commons
Low-Dose Bevacizumab Treatment for Retinopathy of Prematurity
Background: Retinopathy of prematurity (ROP) is an eye disease that affects very premature infants and causes blindness. Treatment for ROP consists of anti-VEGF intravitreal injections (e.g., bevacizumab), laser therapy, and cryotherapy. The concern of anti-VEGF intravitreal injections is systemic toxicity and potential detrimental effects on these developing infants. In research trials, doses as low as 0.031 mg of bevacizumab have been shown to be effective in treating ROP. However, in clinical practice, the most common doses used are 0.125-0.25 mg.
Objectives/Goal: At CMKC, 0.075 mg doses of bevacizumab have been used to treat Type 1 ROP since 2022. We aim to share the outcomes of treating type 1 ROP using low-dose bevacizumab injections. These results may impact how we and other physicians treat ROP in the future.
Methods/Design: Between March 2022 and November 2024, 39 infants were treated for Type 1 ROP with intravitreal bevacizumab at CMKC. We excluded seven patients: two who were lost to follow up, three who transferred care prior to completion of ROP examination, and two actively being followed post-intravitreal injection. In total, 32 patient outcomes were included in our analyses.
Results: Four patients received a second intravitreal injection in one or both eyes, and one patient received a third injection in one eye for recurrent disease. Additionally, panretinal laser photocoagulation with an 810nm wavelength diode laser was used to treat recurrent disease in anterior zone 2 or zone 3. 25 patients (78.1%) received laser treatment for recurrent disease. Two patients (6.25%) received laser treatment for persistent avascular retina (PAR). Seven patients (21.9%) achieved complete vascularization after 0.075 mg intravitreal injection and did not require laser. Of note, one patient experienced a late retinal detachment, at 89 weeks GA. This was 34 weeks after the patient’s last treatment and 26 weeks after the exam confirming complete regression of ROP. Importantly, this patient was the only to receive a third bevacizumab injection in addition to two rounds of laser in the eye of interest due to severe and recalcitrant ROP.
Conclusions: This study supports lower dose intravitreal bevacizumab in clinical practice. Lower doses of bevacizumab reduce the systemic load of the drug and thus potential side effects. One difference with the lower dose of bevacizumab is the higher potential for reactivation of ROP. However, this lower dose allows for the flexibility to treat patients with a second injection, rather than laser, with the total anti-VEGF administered equal to one standard injection. Head-to-head trials comparing low and standard doses should be conducted.
