Anterior segment ischemia after laser for retinopathy of prematurity previously treated with antivascular endothelial growth factor

• Published in: Journal of AAPOS Vol. 25; no. 3; pp. 155.e1 - 155.e5
• Main Authors: Castillejo Becerra, Clara M., Mansukhani, Sasha A., Sagaser, Samantha D., Mammo, Danny A., Bothun, Erick D., Quiram, Polly A., Mohney, Brian G.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-06-2021
• ISSN: 1091-8531; 1528-3933
• DOI: 10.1016/j.jaapos.2021.01.007

To assess the risk of vision-threatening anterior segment ischemia (ASI) among retinopathy of prematurity (ROP) patients treated with anti-VEGF followed by laser photocoagulation.
The medical records of all infants treated for threshold ROP with laser photocoagulation with and without prior anti-VEGF injections from January 1, 2002, through December 2018 at Mayo Clinic were retrospectively reviewed for the prevalence of vision-threatening ASI.
A total of 241 eyes of 122 infants were included. Mean gestational age was 25.1 weeks (range, 22.9-28.7); mean birth weight was 687.6 g (range, 360–1310 g). Of the 54 eyes (27 patients) treated with anti-VEGF prior to laser, 4 developed ASI (including corneal edema, cataracts, and choroidal effusion) compared with 2 of the 187 eyes (95 patients) treated with laser therapy alone (P = 0.008). Infants receiving both anti-VEGF and laser had a younger gestational age at birth (24.5 vs 25.3 weeks; P < 0.001) and lower birth weight (591.4 g vs 715.0 g; P < 0.001) than those who received laser alone. In multivariate analysis, early gestational age at birth was associated with development of ASI (P = 0.03); the association with anti-VEGF treatment (P = 0.07) fell short of statistical significance.
The prevalence of vision-threatening ASI was higher among infants treated with intravitreal anti-VEGF followed by laser compared to those treated with laser alone. Further investigation is warranted to confirm this finding and identify potential factors for decreasing the risk of ASI.