From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA.
From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA.
Am J Ophthalmol. 2022 Aug;240:252-259. doi: 10.1016/j.ajo.2022.03.020. Epub 2022 Mar 31.
To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser.
Retrospective clinical cohort study.
We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment.
In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment.
Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.
比较接受玻璃体内注射贝伐单抗（IVB）或激光治疗的早产儿视网膜病变（ROP）前的近视进展和屈光不正。
回顾性临床队列研究。
我们确定了 2011 年至 2020 年期间接受 IVB 治疗的ROP 早产儿，并将他们的纵向睫状肌麻痹屈光数据与同一时期接受激光治疗的ROP 婴儿的屈光数据进行比较。一部分接受 IVB 治疗的婴儿还接受了额外的激光治疗。我们纳入了 789 次累积就诊的睫状肌麻痹验光数据，中位数随访时间为 3.2 年。我们使用具有对数衰减函数的线性混合效应模型评估治疗后屈光随年龄的变化。
总体而言，模型估计了一个显著的（P<0.001）屈光趋势，从轻度远视到更近视的状态。然而，激光治疗眼的进展速度更快，这与是否接受 IVB 治疗无关。激光点数越多，近视进展增加约 0.16 屈光度/每 100 个激光点数。ROP 分期和区均对近视进展有显著影响，疾病越严重，近视进展越快。随机效应，包括左眼和右眼的个体变异嵌套方差，解释了未被年龄和治疗解释的剩余方差的 86.4%。
严重 ROP 的激光治疗增加了严重近视的趋势。在我们的样本中，IVB 不会影响近视进展，但确实大大减少了治疗 ROP 所需的后续激光治疗量。在考虑 ROP 分期和区的差异后，激光的影响仍然存在。
