Retinopathy of prematurity: preferred practice patterns among pediatric ophthalmologists

Abstract

PurposeThe treatment of retinopathy of prematurity (ROP) is not standardized and can vary significantly between providers. This study aims to determine preferred practices in treating ROP by globally surveying pediatric ophthalmologists.MethodsBetween January and February 2017, an international pediatric ophthalmology interest group was invited to complete an anonymous survey of 18 questions. The main objectives were to determine the preferred first line of treatment for ROP, the preferred dosage of intravitreal bevacizumab (IVB) used, and the outcome and possible complications following bevacizumab injection.ResultsOut of 101 pediatric ophthalmologists, 72 (71.8%) stated that they had direct involvement in the treatment of ROP. When presented with type 1 ROP which requires treatment, 69 ophthalmologists (68.3%) stated that they prefer laser treatment over bevacizumab, and 33 ophthalmologists (32.7%) stated they would recommend bevacizumab as a first choice. Ninety-three ophthalmologists (92.1%) reported the success of 1 laser treatment between 75% and 100%, and 35 ophthalmologists (34.7%) perceive bevacizumab to be 75%–100% successful. Half dose of adult-prescribed bevacizumab at 0.625 mg/0.05 mL was preferred by 47 of the ophthalmologists (46.5%). No cases of endophthalmitis were reported with intravitreal injection.ConclusionLaser photoablation remains the preferred mode of treatment for ROP among surveyed ophthalmologists across the world. Though bevacizumab is currently being used, this form of treatment is not as common, primarily due to the unknown safety profile and potential long-term ramifications of the drug.

Anti-vascular endothelial growth factor in the management of retinopathy of prematurity: A survey among the members of Indian Retinopathy of Prematurity Society

“…Fouzdar Jain et al . [ 17 ] in their survey of pediatric ophthalmologists reported that laser was the preferred modality of treatment and bevacizumab was the preferred anti-VEGF. In a survey from USA, 54% respondents preferred anti-VEGF as a primary modality for the treatment of zone 1 ROP with plus disease and bevacizumab was the preferred agent (78%).…”

“…Survey questionnaire was developed by reviewing previously conducted surveys among vitreoretinal surgeons[ 16 ] and pediatric ophthalmologists[ 17 ] and adapting them to the Indian scenario.…”

Response of Pediatric Choroidal Neovascularization to Anti-Vascular Endothelial Growth Factor

“…Further, a randomized clinical trial investigating pediatric dosing requirements of anti-VEGF for treatment of a variety of exudative conditions showed that 63% of cases resolved after a single injection, with the remaining cases resolving after two injections. With the exception of neonates, the dose of VEGF inhibitors used in the pediatric population is typically 0.625 mg/0.025 mL [5]. However, it is very possible that small children may achieve favorable outcomes with reduced dosing.…”

The Use of Bevacizumab in the Treatment of Retinopathy of Prematurity

“…25 A survey of 101 international pediatric ophthalmologists found that 59.4% used postoperative antibiotic eye drops for at least 3 days following injection. 32 Typically, the neonatal standard of care dosage of IVB injection is 0.625 mg, half the adult dose, possibly due to lower weight and decreased renal clearance. 20 It is imperative to limit the levels of bevacizumab in the serum since infants rely on proper VEGF levels for organ development.…”

“…Other published studies have used topical antibiotics, such as levofloxacin, to prepare the eye before treatment 25. A survey of 101 international pediatric ophthalmologists found that 59.4% used postoperative antibiotic eye drops for at least 3 days following injection 32…”