Comparison of respiratory outcomes in children treated with intravitreal bevacizumab versus laser for severe retinopathy of prematurity: a prospective cross-sectional study

Systemic absorption of intravitreal bevacizumab (IVB) results in reduced VEGF serum levels. VEGF is critical for lung development. This study aims to compare respiratory function in premature children treated for severe retinopathy of prematurity (ROP) with IVB or laser at 8–14 years of age. This is a prospective cross- sectional comparative study. Inclusion criteria were treatment for severe ROP with 0.625 mg IVB or laser and minimum age of 8 years. Exclusions were significant congenital or acquired respiratory anomalies, IVB for compassionate reasons and combined IVB and laser treatment. Primary outcome was forced expiratory volume in one second (FEV1). Secondary outcomes included resting respiratory rate (RR) and oxygen saturation (SpO2). Data on neonatal respiratory illnesses were collected. Thirty-four children were included (16 [26 eyes] IVB, and 18 [35 eyes] laser). The [mean ± SD (range)] gestational age [25.2 ± 1.1 (23.7–27.5) vs. 26.3 ± 2.0 (23.6–32) weeks, p = 0.046], postmenstrual age at treatment [37.0 ± 2.6 (33.6–42.0) vs. 38.6 ± 3.3 (33.1–46.7) weeks, p = 0.036], age at study visit [9.5 ± 1.2 (7.8–11.9) vs. 11.1 ± 2.02 (7.9–13.9) years, p = 0.008], SpO2 [98.3 ± 1.2 (96–100) vs. 98.5 ± 1.2 (96–100) %, p = 0.63], and RR [18.0 ± 3.0 [14–23] vs. 20.0 ± 6.0 (10–30) breaths per minute, p = 0.27] for the IVB and laser groups, respectively. Eleven IVB and 14 laser treated children completed spirometry. The proportion of FEV1% predicted under 80% was (18% vs. 36%, p = 0.41), mean (88.0 ± 9.5 vs. 81.6 ± 14.2, p = 0.19) for IVB compared to laser groups. There were no statistically significant differences in prevalence of bronchopulmonary dysplasia, need and duration of mechanical ventilation, duration of CPAP or low flow oxygen between the two groups. Bevacizumab treated children were more premature, treated earlier and younger at respiratory function testing. Despite these differences that would disadvantage IVB cohort, the respiratory findings were similar between the bevacizumab and laser treated children at 8 years of age.