OSLI Retina

September 2020

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September 2020 · Vol. 51, No. 9 487 Nonetheless, use of anti-vascular endothelial growth factor (VEGF) agents in the treatment of type 1 ROP re- mains controversial, in part due to concerns about ad- verse neurodevelopmental effects. In premature infants, serum VEGF levels are known to be suppressed for two months after intravitreal bevacizumab, with unknown systemic effects. 14 In addition, possible ocular compli- cations include late reactivation and the risk of RD. 15-17 Long-term efficacy and safety data regarding anti- VEGF in neonates are sparse. The purpose of this study is to evaluate two-year ocular and neurodevelopmental outcomes among infants treated with anti-VEGF injec- tion or laser following the initial publication of BEAT- ROP in 2011. PATIENTS AND METHODS This retrospective cohort study used the IBM Mar- ketScan Research Database from the years 2011 to 2017. The MarketScan Commercial Database includes ap- proximately 25 to 60 million employees, retirees, and their dependents each year with employer-sponsored health insurance. The MarketScan Inpatient Services table includes demographic, provider, and insurance information. As these data are de-identified and con- formed to the requirements of the United States Health Insurance Portability and Privacy Act, the University of Chicago Institutional Review Board determined the study to be exempt. Infants were selected for inclusion based on Inter- national Classification of Diseases, version 9 (ICD-9) and version 10 (ICD-10) and Current Procedural Ter- minology (CPT) codes. The diagnosis of ROP required an appropriate ICD code (Table A, available at www. healio.com/OSLIRetina). To identify infants treated for ROP, diagnosis was combined with a CPT code for ei- ther intravitreal injections or laser. Study subjects were followed for 2 years beginning on the date of first treat- ment. Infants treated between 2011 and 2015 were in- cluded. Infants were excluded if they had any gaps in insurance coverage during the first 2 years after treat- ment or if they received simultaneous laser and injec- tion as the initial treatment. Baseline comorbidities included neurological com- plications — any diagnosis of hydrocephalus, periven- tricular leukomalacia (PVL), or stage 3 or 4 intraven- tricular hemorrhage (severe IVH); thrombocytopenia; sepsis; bronchopulmonary dysplasia (BPD); necrotizing enterocolitis (NEC); patent ductus arteriosus (PDA) re- pair; length of stay (LOS); gender; and geographic U.S. census region. Ocular outcomes included RD, vitreous hemorrhage, cataract, glaucoma, strabismus, corneal scar, and endo- Figure 1. Infants in the Mar- ketScan Research Database with ICD codes indicative of retinopa- thy of prematurity (ROP). Infants were included in this study if CPT codes indicated treatment with laser or injection. Treated infants were excluded if insurance cov- erage was not continuous during the 2 years following treatment, or if they received simultaneous la- ser and injection procedures..

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