Effect of Initial Intravitreal Bevacizumab (Avastin) Prior to Retinal Laser Ablation in Threshold Retinopathy of Prematurity

Purpose: The aim of the study is to evaluate the shortterm efficacy of intravitreal injections of bevacizumab for severe threshold retinopathy of prematurity (ROP) prior to retinal laser ablation in comparison to retinal laser ablation alone. Method: A prospective interventional controlled study was conducted on 26 patients with vascularly active ROP considered at high risk for progression or development of tractional retinal detachment. 10 Patients received an intravitreal injection of bevacizumab (0.5mg) as the initial treatment followed by laser ablation of the ischemic retina 3 days later. 16 Cases recevied laser photoablation as the only treatment. RetCam (Clarity Medical Systems, Inc., Pleasanton, CA) photography was used to document effect. Results: After injection of bevacizumab as the initial treatment, reduced neovascular activity was seen on fundus digital photography in all eyes. In three eyes, the fibrous component progressed after bevacizumab injection but without progression to tractional retinal detachment. No other ocular or systemic adverse effects were identified. The ROP stabilized in all cases treated with initial intravitreal Avastin allowing laser supplementation. Conclusion: The combination of intravitreal bevacizumab injection followed by indirect laser photocoagulation was well tolerated and induced prompt regression of aggressive threshold ROP.