Role of deferred retinal laser following intravitreal injection of bevacizumab in treatment of severe retinopathy of prematurity

PURPOSE: The purpose is to determine the advantages and role of supplemental deferred retinal laser treatment following intravitreal bevacizumab (IVB) monotherapy in cases of severe retinopathy of prematurity (ROP) requiring treatment. MATERIALS AND METHODS: This is a retrospective study involving preterm infants diagnosed with treatment requiring ROP, treated initially with bevacizumab monotherapy who subsequently received deferred laser treatment during the study period from April 2019 to March 2021. Deferred laser treatment was done when recurrence of ROP or plus disease was noted or nonprogression of retinal vasculature was noted on two consecutive examinations over 2 weeks. The main outcomes measured were the ability of the treatment to prevent ROP progression or recurrence and anatomic outcome at the last follow-up visit. RESULTS: Twenty-three eyes of 14 neonates were treated with a deferred laser treatment following the initial intravitreal injection of Bevacizumab. The mean postmenstrual age at which IVB was given was 34(+6) ± 1(+3) weeks. The mean duration between IVB and retinal laser was 5(+3) ± 3(+4) weeks. The mean weight at the time of injection was 1317.8 ± 231.8 g. The mean weight of the infants at the time of the laser was 2050 ± 813.9 g. None of the eyes developed recurrence or adverse anatomical outcomes following laser till the last available follow-up. CONCLUSIONS: In our small number of subjects, blinding complications of ROP were prevented by using a deferred laser treatment protocol following initial bevacizumab therapy in treatment requiring ROP. It is better suited in cases where compliance for long-term follow-up after bevacizumab therapy cannot be ensured.