Retinal Vascularization Rate Predicts Retinopathy of Prematurity and Remains Unaffected by Low-Dose Bevacizumab Treatment - 28/05/25
Highlights |
• | Ultra-widefield imaging enables monitoring of retinal vascularization rate. |
• | Slow retinal vascularization is an early predictor of treatment-requiring retinopathy of prematurity. |
• | Low-dose bevacizumab does not slow physiological retinal vascularization. |
Résumé |
PURPOSE |
To assess the rate of retinal vascularization derived from ultra-widefield (UWF) imaging-based retinopathy of prematurity (ROP) screening as predictor of type 1 ROP and characterize the effect of anti–vascular endothelial growth factor (anti-VEGF) therapy on vascularization rate.
DESIGN |
Retrospective, consecutive cohort study.
SUBJECTS |
The study included 132 eyes of 76 premature infants with a mean gestational age (GA) of 26.0 (±2.0 SD) weeks and birthweight (BW) of 815 (±264) g, who underwent longitudinal UWF imaging for ROP screening, at a level 3 neonatal unit in Oxford, United Kingdom.
METHODS |
The extent of retinal vascularization on each UWF image was measured as the ratio between “disc-to-temporal vascular front” and “disc-to-fovea” distance along a straight line bisecting the vascular arcades. Measurements from ≥3 time points plotted against post-menstrual age (PMA) enabled calculation of temporal vascularization rate (TVR) for each eye. Using TVR, GA, and BW as predictors, a machine learning model was created to classify eyes as either group AB (no ROP and type 2 ROP) or group C (type 1 ROP). The model was validated in a withheld cohort of 32 eyes (19 infants), of which 8 eyes (5 infants) required treatment. TVR in 37 eyes (20 infants) was compared before and after ultra-low-dose (0.16 mg) intravitreal bevacizumab treatment.
MAIN OUTCOME MEASURES |
The rate of retinal vascularization was determined.
RESULTS |
Slower retinal vascularization correlated with increasing ROP severity, with TVR being 29% slower in group C eyes (n=50) than group AB eyes (n=33 no ROP and n=49 type 2 ROP) (P = .04). Our model correctly predicted ROP outcomes of 30/32 eyes, achieving a balanced accuracy of 95.8%. No significant change in TVR was found before and after bevacizumab treatment with mean posttreatment imaging follow-up of 7.7 (±7.9) weeks (P = .60 right eyes, P = .71 left eyes).
CONCLUSIONS |
UWF imaging-based ROP screening enables quantification of retinal vascularization rate, which can provide early prediction of type 1 ROP independent of BW and GA. Rate of physiological retinal vascularization does not appear to be significantly affected by ultra-low-dose anti-VEGF treatment, which has significant implications for the development of peripheral avascular retina and timing of anti-VEGF intervention to prevent disease progression in high-risk infants.
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| Supplemental Material available at AJO.com. |
|
| Emer Chang and Amandeep Josan contributed equally as co-first authors. |
Vol 275
P. 74-87 - juillet 2025 Retour au numéro
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