Long term anatomic and functional results of agressive posterior retinopathy of prematurity treatment

Purpose: Retrospective analysis of long-term refractive status, anterior and posterior segment ocular findings of patients treated for aggressive posterior retinopathy of prematurity (AP-ROP). Methods: Between January 2009 and December 2015, 94 eyes of 47 cases who were treated and followed-up with the diagnosis of AP-ROP and 70 eyes of 35 cases who were born premature but did not develop retinopathy of prematurity (ROP) were screened retrospectively. The cases were divided into laser photocoagulation, anti-VEGF injection and control groups according to treatment. Slit lamp and fundus examination findings, presence of amblyopia, anisometropia and strabismus of all cases were evaluated. Cycloplegic refractions, best corrected visual acuity (BCVA), axial length (AL) were recorded. Results: The groups were similar in terms of gestational week (GW), birth weight (BW), and treatment week. The disease rate was higher in the injection group in zone 1 and in the posterior zone 2 in the laser group (p=0.016). The recurrence rate after treatment was 37.5% in the laser group, the recurrence time was 2.9 ± 1.2 weeks, in the injection group the recurrence rate was 26.6%, and the recurrence time was 8.5 ± 1.7 weeks. Late recurrence in the injection group was statistically significant (p<0.001). Pars plana vitrectomy (PPV) was required in 14 eyes (21.8%) in the laser group, and none in the injection group. The laser group was more myopic when the mean spherical equivalents (SE) of the patients were evaluated at the last visit (p=0.008). The mean BCVA was better in the injection group at the last visit (p=0.001). When BCVA and SE of the control group were compared with the treatment groups, the control group was better in terms of both parameters (p<0.001). The anisometropia rate in the laser group (%63) was higher than the injection group (%40) (p=0.005), no significant difference was found in amblyopia. Favorable anatomical outcome was % 67,19 in the laser group and %96,67 in the injection group (p<0,05). Strabismus was observed in 29.7% of all the cases, the predominant type was esotropia. When the groups were evaluated in terms of AL, the averages were similar (22,70±1,78, 22,53±1,59). The AL of the laser group, mean age of 9-11, was found to be statistically significantly longer than the control group (p<0.05). Conclusion: The injection group was better than the laser group in terms of need for additional treatment, surgical need, and long-term anatomical outcome, visual acuity and refractive status. Intravitreal bevacizumab injection may be preferred as the first treatment option in cases with AP-ROP. Keywords: Aggressive posterior retinopathy of prematurity, axial length, bevacizumab, laser photocoagulation, refractive status.