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   Table of Contents      
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 6  |  Page : 877-878

Commentary: Continuation of care - Refraction beyond regression


Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India

Date of Web Publication24-May-2019

Correspondence Address:
Dr. Manavi D Sindal
Vitreo-Retina Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry - 605 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_767_19

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How to cite this article:
Sindal MD, Arthi M. Commentary: Continuation of care - Refraction beyond regression. Indian J Ophthalmol 2019;67:877-8

How to cite this URL:
Sindal MD, Arthi M. Commentary: Continuation of care - Refraction beyond regression. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jun 19];67:877-8. Available from: http://www.ijo.in/text.asp?2019/67/6/877/259062



Retinopathy of prematurity (ROP) is a disease like none other. It affects a specific strata of the population, premature babies, who are affected at a very specific time. Its screening and treatment, however, is very effective, as timely treatment can have excellent outcomes with near complete resolution of the disease. On the other hand lack of screening and treatment can render a baby blind. An all-or-none phenomenon unlike any other. With an increasing number of premature babies being born with improving survival, the need for ROP management is set to increase in the future.[1] The treatment options for ROP has improved by leaps and bounds – from CryoROP to ETROP and to BEAT ROP. The initial use of cryotherapy to ablate avascular retina moved on to use of laser, which today is the standard of care. BEAT ROP introduced the use of bevacizumab in posterior ROP.[2] The changing modalities have shown improving anatomical and visual outcomes in children.

Parents and treating doctors heave a sigh of relief once disease is well regressed. But the management of ROP does not end there. Long term visual rehabilitation is the key to achieving optimal visual outcomes. In the article “Refractive, Sensory and Biometric outcome among ROP children with a history of laser therapy- A Retrospective review from a tertiary care centre in South India”, the authors highlight the long term refractive concerns in babies successfully treated for ROP.[3] Certain delayed complications such as cataract, glaucoma and retinal detachment, in addition to refractive errors and strabismus necessitate lifelong follow-up of babies treated for ROP. A baby successfully treated for ROP can still have suboptimal visual outcomes if refractive errors go uncorrected or if secondary complications are not addressed.

Laser for ROP has long been recognised to cause more refractive errors in treated babies than in babies born preterm but not needing laser. The follow-up of the BEAT-ROP cohort at 2 years showed there was significantly less refractive error in babies who had received bevacizumab vs those receiving laser, along with better preservation of visual field.[4] Use of bevacizumab, is currently recommended for posterior disease - in zone 1 or posterior zone 2. While satisfactory ocular outcomes are well established, the effect of anti VEGF on developing tissue in other organ systems is not known. Literature has some reports that have shown an increased incidence of psychomotor delays in babies receiving bevacizumab when compared with those who had received laser treatment [5], while another report from a sub set of the BEAT ROP cohort did not report any developmental issues.[6] A modality of treatment that allows ocular growth and vascularisation to progress unhampered without any systemic or neurodevelopmental concerns is the desired panacea for ROP. Until then, not just resolution of disease but refraction for optimal visual outcomes is the mantra for all!



 
  References Top

1.
Dhingra D, Katoch D, Dutta S, Samanta R, Aggarwal K, Dogra MR. Change in the incidence and severity of retinopathy of prematurity (ROP) in a neonatal intensive care unit in Northern India after 20 years: Comparison of two similar prospective cohort studies. Ophthalmic Epidemiol 2019:1-6. doi: 10.1080/09286586.2018.1562082.  Back to cited text no. 1
    
2.
Mintz-Hittner HA, Kennedy KA, Chuang AZ; BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+retinopathy of prematurity. N Engl J Med 2011;364:603-15.  Back to cited text no. 2
    
3.
Anilkumar SE, Anandi V, Shah PK, Ganesh S, Narendran K. Refractive, sensory, and biometric outcome among retinopathy of prematurity children with a history of laser therapy: A retrospective review from a tertiary care center in South India. Indian J Ophthalmol 2019;67:871-6.  Back to cited text no. 3
  [Full text]  
4.
Geloneck MM, Chuang AZ, Clark WL, Hunt MG, Norman AA, Packwood EA, et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: A randomized clinical trial. JAMA Ophthalmol 2014;132:1327-33.  Back to cited text no. 4
    
5.
Morin J, Luu TM, Superstein R, Ospina LH, Lefebvre F, Simard MN, et al. Canadian Neonatal Network, Canadian Neonatal Follow-Up Network Investigators. Neurodevelopmental outcomes following bevacizumab injections for retinopathy of prematurity. Pediatrics 2016;137:e20153218.  Back to cited text no. 5
    
6.
Kennedy KA, Mintz-Hittner HA; BEAT-ROP Cooperative Group. Medical and developmental outcomes of bevacizumab versus laser for retinopathy of prematurity. J AAPOS 2018;22:61-5.  Back to cited text no. 6
    




 

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