A comparison of respiratory outcomes after treating retinopathy of prematurity with laser photocoagulation or intravitreal bevacizumab.
To compare respiratory outcomes following treatment of retinopathy of prematurity (ROP) between infants treated with laser under general anesthesia to infants treated with intravitreal bevacizumab under bedside sedation.Retrospective cohort study.138 consecutive infants treated for ROP from September 2010 to September 2018 at one institution.Retrospective medical, procedural, and ophthalmologic data were collected, including pre-procedure (baseline) and post-procedure (24 hours, 48 hours, 7 days, and 28 days) respiratory status; birth weight; gestational age; gender; ROP treatment modality; postmenstrual age (PMA) at treatment; and coincident non-ocular procedures during anesthesia. Respiratory outcomes at 48 hours were compared between infants treated with laser under general anesthesia and infants treated with intravitreal bevacizumab under local sedation, using multivariable logistic regression analysis to control for potentially confounding factors.Proportion of infants who had returned to their respiratory baseline by 48 hours after ROP treatment.Return to respiratory baseline was significantly less common among 119 infants initially treated with laser compared to 19 infants initially treated with bevacizumab at 24 hours (40% versus 74%, p = 0.0115), 48 hours (53% versus 79%, p = 0.0453), and 7 days (79% versus 100%, p = 0.0242). In a multivariable logistic regression analysis, infants treated with laser were less likely to return to respiratory baseline at 48 hours (odds ratio 0.14, 95% CI 0.04-0.54). At 28 days, there was no difference between groups (laser 97%, bevacizumab 100%, p > 0.99).Infants treated with intravitreal bevacizumab using bedside sedation returned to their pre-procedure respiratory baseline faster than infants treated with laser under general anesthesia, with the differences persisting at least to 7 days post-procedure or more.