Bilateral Effect of Unilateral Bevacizumab Injection in Retinopathy of Prematurity

Neurodevelopmental Outcomes Following Bevacizumab Injections for Retinopathy of Prematurity

“…Given the prolonged halflife of bevacizumab and its potential antiangiogenic effect beyond the eye, it is crucial to document the whole-body effects of this drug, especially in preterm infants who are still undergoing organogenesis. [12][13][14] Disturbance of vascular development at the cerebral level could be detrimental to brain development and potentially result in adverse motor, cognitive, and language outcomes. To our knowledge, only 1 case series including 13 very preterm infants revealed the long-term effect of bevacizumab, but used a screening developmental test and lacked a control group.…”

What is the evidence for systemic effects of intravitreal anti-VEGF agents, and should we be concerned?

“…Furthermore, studies have now measured bevacizumab in the bloodstream after intravitreal injection for ROP with a significant reduction in VEGF levels 35. In addition, fellow eye effects have also been reported in ROP 36. These immature babies are still undergoing organogenesis, and VEGF is involved in many processes, including lung maturation 11.…”

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity

“…In 25 trials no systemic complications were reported [43–44,47,49–50,57,59,62,64–68,74–85]. There was one report of short-term raised liver enzymes after bevacizumab injection [61] and one case report showing reduced vascular activity in the contralateral eye [5]. …”

“…Although laser photocoagulation is successful in many cases, it might reduce the visual field [3] and contribute to the development of myopia [4]. Therefore, an alternative may be useful [5]. …”

“…However, laser photocoagulation may destroy large areas of the retina [5]. Therefore an alternative treatment is of interest, especially for preterm infants with zone 1 ROP.…”