Observations of simultaneous aggressive anemia correction and intravitreal therapy for aggressive retinopathy of prematurity: A multimodal retinopathy of prematurity assessment study report number 2

Objective: To study the effect of simultaneous aggressive anemia correction and intravitreal anti-vascular endothelial growth factor (anti-VEGF) Bevacizumab in aggressive retinopathy of prematurity (A-ROP) using multimodal imaging biomarkers. Methods: Noncontact ultra-widefield fundus imaging with integrated UWF-guided swept source optical coherence tomography (SS-OCT) was performed prospectively before and after intravitreal anti-VEGF (Bevacizumab) monotherapy. For all babies with anemia (hemoglobin <10 g/dL), blood transfusion was requested by the treating ophthalmologist in coordination with the treating neonatologist. Imaging outcomes of babies who were transfused (Group 1, 40 eyes of 20 babies) were compared to those of babies who did not undergo transfusion (Group 2, 40 eyes of 20 babies). All babies in our study were stable and not receiving supplemental oxygen. Results: Group 1 eyes showed faster resolution of multilayered hemorrhages ( P value 0.030) and faster vascular progression to zone 3 ( P value 0.004). Group 2 A-ROP eyes had a higher incidence of reactivation ( P value 0.038), higher incidence of persistent avascular retina (PAR) ( P value 0.044), and need for retreatment with laser ( P value 0.001) when compared to Group 1. Resolution of ischemic OCT biomarkers, resolution of hyperreflectivity of the inner retinal layers, and improvement in choroidal thickness >250 microns were better in Group 1 than in Group 2. Conclusion: Prompt correction of moderate to severe anemia with blood transfusion in anti-VEGF-injected A-ROP eyes resulted in faster resolution of retinal hemorrhages and faster vascular progression to the periphery. These eyes showed improved multimodal imaging biomarkers and a lower chance of reactivation or PAR needing retreatment with laser.