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Evaluation of optical coherence tomography biomarkers to differentiate favourable and unfavourable responders to intravitreal anti-vascular endothelial growth factor treatment in retinopathy of prematurity

Eye volume 38, pages 1097–1103 (2024)Cite this article

Subjects

Abstract

Objective

Evaluation of optical coherence tomography biomarkers in predicting treatment response to intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) Bevacizumab, in aggressive retinopathy of prematurity (A-ROP).

Methods

Non-contact ultra-widefield (NC-UWF) fundus imaging with integrated UWF guided swept source Optical coherence tomography (SS-OCT) was performed prospectively in preterm babies before and after intravitreal anti-VEGF (Bevacizumab) monotherapy. OCT biomarkers were analysed in eyes that reached complete vascularization versus others.

Results

Eyes with retinal vessels reaching near ora serrata were labelled as regressed ROP and vascularised retina (Group1). Eyes with reactivation of ROP needing laser or vitreoretinal surgery or eyes with peripheral avascular retina (PAR) at 16th week post-injection were considered as Group 2. Pre-injection baseline OCT showed a hyperreflectivity of inner retinal layers in 12 out of 46 eyes in Group 1 versus 30 out of 34 eyes in Group 2 (p value 0.002). None of the eyes in Group 1 showed choroidal thinning at posterior pole as compared to 14 out of 34 eyes in Group 2 (p value 0.001). Intraretinal hypo reflective Cystic changes at fovea were seen in 16 out of 46 eyes in Group 1 and 2 out of 34 eyes in Group 2 (p value 0.012).

Conclusion

Pre-injection swept source OCT biomarkers could predict the treatment outcomes of anti-VEGF (Bevacizumab) monotherapy in A-ROP eyes. Hyperreflectivity of inner retinal layers and choroidal thinning had poorer and unpredictable response to anti-VEGF injection whereas, cystic changes at fovea predicted favourable response.

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Fig. 1: The babies were covered with warm clothing and held in the modified ‘flying baby position’, with one arm supporting the chest/chin and the other hand supporting the head.
Fig. 2
Fig. 3: Evaluation of optical coherence tomography (OCT) biomarkers.
Fig. 4: Evaluation of optical coherence tomography (OCT) biomarkers.
Fig. 5: Evaluation of optical coherence tomography (OCT) biomarkers.

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Data availability

Data set is available with author Akash Belenje and at ROP database office at LV Prasad Eye Institute, Hyderabad, Telangana, India-500034.

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Funding

Hyderabad Eye Research Foundation (2020), Hyderabad, India The institute has received funding or support for its ongoing Retinopathy of Prematurity programs from Miriam Hyman Memorial Trust (MHMT, UK), Dalmia Holdings (India), Queen Elizabeth Diamond Jubilee Trust (UK), Public Health Foundation of India, Cognizant Foundation and the Government of India.

Author information

Authors and Affiliations

  1. Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Akash Belenje, Rakasi Ugandhar Reddy, Deepika C. Parmeswarappa, Bala Subbarao & Subhadra Jalali

  2. Vitreoretinal and Uveitis Services, Anant Bajaj Retina Institute, Mithu Tulsi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India

    Tapas Ranjan Padhi

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  1. Akash Belenje
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Contributions

AB and SJ: devised and designed the study, devised data collection protocol and data analysis, Literature search, wrote the Manuscript. DCP and TRP: helped in improving content and editing the manuscript. RUR and BS: captured the fundus and OCT images on Optos silverstone.

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Correspondence to Subhadra Jalali.

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IRB approved with ethics number LEC-BHR-P-09-22-926.

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Belenje, A., Reddy, R.U., Parmeswarappa, D.C. et al. Evaluation of optical coherence tomography biomarkers to differentiate favourable and unfavourable responders to intravitreal anti-vascular endothelial growth factor treatment in retinopathy of prematurity. Eye 38, 1097–1103 (2024). https://doi.org/10.1038/s41433-023-02824-1

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